Delirium in Children Undergoing Hematopoietic Stem Cell Transplants

项目摘要/摘要 精神错乱--定义为意识和认知的急剧变化，发生在潜在的 疾病是成人造血干细胞移植(HSCT)的常见并发症， 相关的发病率和死亡率。这在儿童中从未被研究过，因为儿童的风险因素可能不同。 基本上来自成年人。这项研究的中心假设是，接受造血干细胞移植的儿童在 在移植围手术期出现精神错乱的风险极高，而且这种精神错乱与不良的预后有关。 此应用程序的目标是：定义精神错乱的流行病学，并测量其对 结果。这项前瞻性纵向队列研究将前瞻性地确定 1,000名儿童在移植围术期，并确定易患精神错乱的可改变的危险因素 发展。这项研究还将确定精神错乱对重要临床结果的影响，包括 神经认知功能。这些结果将导致向围产期儿童提供护理的范式转变。 移植时期。这项研究将由五个领先的儿科肿瘤学研究联盟执行 北美的移植中心，与领先的儿科精神错乱研究小组在 美国。这一创新方案将利用儿童精神错乱和儿童精神错乱的综合经验 HSCT团队将迫切需要的精神错乱研究扩大到一个独特的、未经研究的人群。通过减少 妄想率，儿科HSCT后的结果可以优化。这一建议与美国国立卫生研究院新的 政策以确保研究在整个生命周期内都包含在内，并将促进国家癌症研究所的 促进科学知识的使命，以帮助癌症患者活得更长、更健康。

Project Summary/Abstract Delirium -- defined as an acute change in awareness and cognition that occurs in the setting of an underlying illness -- is a common complication of hematopoietic stem cell transplantation (HSCT) in adults, with associated morbidity and mortality. This has never been studied in children, where risk factors may vary substantially from adults. The central hypothesis of this study is that children undergoing HSCT are at extremely high-risk for delirium during the peri-transplant period, and that delirium is linked to poor outcomes. The objectives of this application are: to define the epidemiology of delirium, and measure its effect on outcomes. This prospective longitudinal cohort study will prospectively establish the incidence of delirium in 1000 children in the peri-transplant period, and identify modifiable risk factors that predispose to delirium development. This study will also define the effect of delirium on important clinical outcomes, including neurocognitive function. These results will lead to a paradigm shift in the care delivered to children in the peri- transplant period. This study will be executed by a research consortium of five leading pediatric oncologic transplant centers in North America, in collaboration with the leading pediatric delirium research group in the United States. This innovative proposal will leverage the combined experience of the pediatric delirium and HSCT teams to expand urgently needed delirium research into a unique and unstudied population. By reducing delirium rates, outcomes after pediatric HSCT can be optimized. This proposal is consistent with the NIH’s new policy to ensure research ‘Inclusion Across the Lifespan’, and will further the National Cancer Institute’s mission to advance scientific knowledge in order to help people with cancer live longer, healthier lives.