Longitudinal Study of Dental Caries in VLBW Infants

描述(申请人提供)：这项纵向研究探讨了早产儿极低出生体重(VLBW)和足月正常出生体重(NBW)婴儿的出生体重与早期儿童龋齿(ECC)之间的关系。VLBW和ECC对贫困和少数族裔儿童的影响不成比例，每年花费医疗补助数十亿美元进行治疗。VLBW儿童存活率的提高导致了更多的长期残疾和对卫生服务的需求，从而将他们归类为有特殊卫生保健需要的儿童。极低出生体重儿的口腔健康需求尚未得到充分研究。众所周知，极低出生体重的儿童在乳牙期有很高的釉质缺陷，这反过来又会导致对ECC的易感性增加。在极低出生体重儿中，可能使一些儿童易患ECC的社会行为因素是未知的。因此，本研究的主要目的是(1)评估极低出生体重儿(VLBW)和非出生体重儿(NBW)的ECC发生率；(2)评估釉质发育缺陷、变形链球菌感染和VLBW和新生儿口腔健康行为程度等中介因素；(3)在控制独立调节变量后，通过中介评估出生体重和ECC之间的间接关系。总共200名极低出生体重儿和200名正常出生体重儿将在8个月和18-20个月的矫正年龄进行随访。这项拟议的研究将收集有关龋齿(龋齿和充填表面)、中介生物变量(釉质发育不良和不透明、变形链球菌水平)和婴儿口腔健康行为(喂养、饮食、口腔卫生做法和获得牙齿)以及独立变量(人口统计数据、父母易患疾病、使能、需要特征、牙科行为、生物和儿童医疗因素)的数据。测试目标1和2的数据分析包括广义估计方程(GEE)模型，以及用于测试中介在目标3中的作用的两阶段结构方程模型(SEM)。样本大小提供了85%到99%的力量来比较这两组在三个研究目标方面的差异。这项研究的结果将为解决照顾极低出生体重儿方面的知识差距提供关键数据。临床意义包括初级预防、早期诊断和治疗，以防止进一步的龋齿易感性。这也符合公共卫生利益，因为针对知识、态度、信念和口腔健康实践的干预措施可以在针对特殊需要儿童的计划中实施，从而改善口腔和全身健康。

DESCRIPTION (provided by applicant): This longitudinal study addresses the relationship between birth weight and early childhood caries (ECC) in a cohort of pre-term very low birth weight (VLBW) and full-term normal birth weight (NBW) infants. VLBW and ECC disproportionately affects poor and minority children costing Medicaid billions of dollars annually for treatment. The improved survival of VLBW children has resulted in greater long-term disabilities and need for health services, thus classifying them as children with special health care needs. The oral health needs of VLBW children have not been adequately studied. VLBW children are known to have a high prevalence of enamel defects in the primary dentition, which in turn can lead to increased susceptibility to ECC. Socio- behavioral factors that can predispose some children to ECC are unknown in VLBW children. Therefore the primary aims of the study are to (1) assess the incidence of ECC in VLBW and NBW infants; (2) assess mediators such as the incidence of developmental enamel defects, S.mutans infection and the extent of oral health behaviors in VLBW and NEW infants; (3) assess the indirect relationship between birth weight and ECC via mediators after controlling for independent moderating variables. A total of 200 VLBW and 200 NBW infants will be followed at 8 and 18-20 months corrected age. The proposed study will collect data on caries (decayed and filled surfaces), mediating biological variables (enamel hypoplasia and opacity, S.mutans levels) and infant oral health behavior (feeding, diet, oral hygiene practices, and dental access), and independent variables (demographics, parent predisposing, enabling, need characteristics, dental behavior, biological and child medical factors). Data analysis for testing aims 1 and 2 includes the generalized estimating equations (GEE) models, and a two-stage structural equations model (SEM) for testing the role of mediators in aim 3. The sample size provide 85 to 99% power to compare the two groups in terms of the three study aims. The results of this study will provide critical data to address the knowledge gaps in taking care of VLBW children. The clinical implications include primary prevention, early diagnosis and treatment to prevent further susceptibility to dental decay. It is also of public health interest since interventions to target knowledge, attitude, beliefs, and oral health practices can be implemented in programs for special needs children, and there by improve both oral and systemic health.