Longitudinal Study of Dental Caries in VLBW Infants

描述（由申请人提供）：这项纵向研究探讨了早产极低出生体重（VLBW）和足月正常出生体重（NBW）婴儿队列中出生体重与幼儿龋齿（ECC）之间的关系。极低出生体重和ECC对贫困和少数民族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。极低出生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。极低出生体重儿童的口腔健康需求尚未得到充分研究。众所周知，极低出生体重儿童在乳牙列中有很高的牙釉质缺陷患病率，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，社会行为因素可能使某些儿童易患ECC，这一点尚不清楚。因此，本研究的主要目的是（1）评估极低出生体重和非出生体重婴儿的ECC发生率;（2）评估介质，如发育性釉质缺陷的发生率、变形链球菌感染和极低出生体重和新生儿口腔健康行为的程度;（3）在控制独立调节变量后，通过介质评估出生体重与ECC之间的间接关系。共200名VLBW和200名NBW婴儿将在8个月和18-20个月矫正年龄时接受随访。拟议的研究将收集有关龋齿（龋齿和填充表面）、介导生物学变量（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访问）以及自变量（人口统计学、父母易感性、使能、需求特征、牙科行为、生物学和儿童医学因素）的数据。测试目标1和目标2的数据分析包括广义估计方程（GEE）模型和两阶段结构方程模型（SEM），用于测试中介体在目标3中的作用。样本量提供了85%至99%的把握度来比较两组在三个研究目标方面的差异。这项研究的结果将提供关键数据，以解决照顾极低出生体重儿童的知识差距。临床意义包括一级预防、早期诊断和治疗，以防止蛀牙的进一步易感性。这也是公共卫生的利益，因为干预措施，以目标知识，态度，信仰和口腔健康的做法，可以在特殊需要的儿童的方案实施，并通过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.