Longitudinal Study of Dental Caries in VLBW Infants

描述（由申请人提供）：本纵向研究在早产儿极低出生体重（VLBW）和足月正常出生体重（NBW）婴儿队列中探讨出生体重与早期儿童龋齿（ECC）之间的关系。VLBW和ECC对贫困儿童和少数民族儿童的影响尤为严重，每年的医疗费用高达数十亿美元。极低体重儿童存活率的提高导致了更大的长期残疾和对保健服务的需求，因此将他们归类为有特殊保健需求的儿童。VLBW儿童的口腔健康需求尚未得到充分的研究。众所周知，VLBW儿童在初级牙列中具有高患病率的牙釉质缺陷，这反过来又会导致对ECC的易感性增加。在VLBW儿童中，可能使某些儿童易患ECC的社会行为因素尚不清楚。因此，本研究的主要目的是：(1)评估VLBW和NBW婴儿中ECC的发生率；(2)评估VLBW和新生儿发育性牙釉质缺陷发生率、变形链球菌感染和口腔健康行为程度等中介因素；(3)在控制了独立调节变量后，通过中介评估出生体重与ECC之间的间接关系。在矫正月龄分别为8个月和18-20个月时，对200名VLBW和200名NBW婴儿进行随访。拟议的研究将收集龋齿（腐烂和填充表面），调节生物变量（牙釉质发育不全和不透明，变形链球菌水平）和婴儿口腔健康行为（喂养，饮食，口腔卫生习惯和牙科就诊）以及自变量（人口统计学，父母易感，使能，需求特征，牙科行为，生物和儿童医学因素）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，以及用于测试目标3中中介作用的两阶段结构方程模型（SEM）。就三个研究目标而言，样本量提供了85%至99%的能力来比较两组。本研究的结果将提供关键数据，以解决照顾VLBW儿童的知识差距。临床意义包括初级预防，早期诊断和治疗，以防止进一步易患蛀牙。这也符合公共卫生利益，因为针对知识、态度、信念和口腔卫生实践的干预措施可以在特殊需要儿童的项目中实施，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.