Delirium in Children Undergoing Hematopoietic Stem Cell Transplants

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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.