Our objective was to establish the rate of neurological involvement in Shiga toxin-producing Escherichia coli–hemolytic uremic syndrome (STEC-HUS) and describe the clinical presentation, management and outcome. A retrospective chart review of children aged ≤ 16 years with STEC-HUS in Children’s Health Ireland from 2005 to 2018 was conducted. Laboratory confirmation of STEC infection was required for inclusion. Neurological involvement was defined as encephalopathy, focal neurological deficit, and/or seizure activity. Data on clinical presentation, management, and outcome were collected. We identified 240 children with HUS; 202 had confirmed STEC infection. Neurological involvement occurred in 22 (11%). The most common presentation was seizures (73%). In the neurological group, 19 (86%) were treated with plasma exchange and/or eculizumab. Of the 21 surviving children with neurological involvement, 19 (91%) achieved a complete neurological recovery. A higher proportion of children in the neurological group had renal sequelae (27% vs. 12%, P = .031). One patient died from multi-organ failure.Conclusion: We have identified the rate of neurological involvement in a large cohort of children with STEC-HUS as 11%. Neurological involvement in STEC-HUS is associated with good long-term outcome (complete neurological recovery in 91%) and a low case-fatality rate (4.5%) in our cohort. What is Known:• HUS is associated with neurological involvement in up to 30% of cases.• Neurological involvement has been reported as predictor of poor outcome, with associated increased morbidity and mortality. What is New:• The incidence of neurological involvement in STEC-HUS is 11%.• Neurological involvement is associated with predominantly good long-term outcome (90%) and a reduced case-fatality rate (4.5%) compared to older reports.

Objective Adolescence is a time of significant change for patients, guardians, and clinicians. The Paediatrician must ensure patients develop the necessary skills and knowledge required to transition and to function as an independent entity, with autonomy over their own care. The transfer from paediatric to adult care carries an increased risk of graft-related complications attributable to a multitude of reasons, particularly non-adherence to immunosuppressant medicines and poor attendance at scheduled appointments. This systematic review was conducted to ascertain the transitional care models available to clinicians caring for kidney transplant recipients and to compare the approach in each respective case. Method A systematic review was performed, in a methodology outlined by the PRISMA guidelines. MEDLINE Ovid & EMBASE databases were searched for studies that outlined valid, replicable models pertaining to transitional care of paediatric kidney transplant recipients between 1946 and Q3-2021. The reference lists of selected articles were also perused for further eligible studies and experts in the field for further eligible articles. Two investigators assessed all studies for eligibility and independently performed data extraction, any discrepancies were settled by consensus. Results A total of 1,121 abstracts were identified, which was reduced to 1,029 upon removal of duplicates. A total of 51 articles were deemed appropriate for full-text review and critical appraisal. Twelve articles which described models for transition pertaining to kidney transplant patients were included in qualitative synthesis. Every paper utilised a different transition model. All but one model included a physician and nurse at minimum in the transition process. The involvement of adult nephrologist medical social work, psychology and psychiatry was variable. The mean age for initiation of transition was 13.4 years range: 10-17.5 years. The mean age at transfer to adult services was 18.3 years range: 16-20.5 years. Conclusion Despite the well-established need for good transitional care in paediatric solid-organ transplant recipients, models tailored specifically for kidney transplant recipients are lacking. Further research and validation studies are required, to ascertain the most best method of providing effective transitional care to these patients. Transitional care should become a standardised process for adolescents and young adults with a kidney transplant.

ObjectiveTo determine the aetiology of community acquired pneumonia in children presenting to primary care in Northern Malawi, and to ascertain predictors for identification of children requiring hospitalisation.DesignThe BIOmarkers TO diagnose PnEumonia study was a prospective cohort study conducted from March to June 2016.SettingPrimary care in Northern Malawi.Patients494 children aged 2 –59 months with WHO defined pneumonia.Main outcome(s) and measure(s)Number of children with bacterial infection identified and the sensitivity/specificity of WHO markers of severity for need for hospitalisation.Results13 (2.6%) children had a bacterium consistent with pneumonia identified. A virus consistent with pneumonia was identified in in 448 (90.7%) of children. 56 children were admitted to hospital and two children died within 30 days. 442 (89.5%) received antibiotic therapy. Eleven children (2.6%) had HIV. WHO severity markers at baseline demonstrated poor sensitivity for the need for hospitalisation with a sensitivity of 0.303 (95% CI 0.188 to 0.441) and a specificity 0.9 (95% CI 0.868 to 0.926). A prediction rule to indicate the need for hospitalisation was developed.Conclusions and relevanceThe low rate of bacterial infection and high use of antibiotics in the setting of high immunisation rates highlights the changing profile of childhood pneumonia. Similarly, the markers of need for hospitalisation may have changed in the setting of extended immunisation. Further studies are required to examine this.

Background: Our goal was to identify existing clinical prediction rules for predicting hospitalisation due to lower respiratory tract infection (LRTI) in children in primary care, guiding antibiotic therapy. A validation of these rules was then performed in a novel cohort of children presenting to primary care in Malawi with World Health Organisation clinically defined pneumonia. Methods: MEDLINE & EMBASE databases were searched for studies on the development, validation and clinical impact of clinical prediction models for hospitalisation in children with lower respiratory tract infection between January 1 st 1946-June 30 th 2021. Two reviewers screened all abstracts and titles independently. The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews & Meta-Analyses guidelines. The BIOTOPE cohort (BIOmarkers TO diagnose PnEumonia) recruited children aged 2-59 months with WHOdefined pneumonia from two primary care facilities in Mzuzu, Malawi. Validation of identified rules was undertaken in this cohort. Findings: 1023 abstracts were identified. Following the removal of duplicates, a review of 989 abstracts was conducted leading to the identification of one eligible model. The CHARMS checklist for prediction modelling studies was utilized for evaluation. The area under the curve (AUC) of the STARWAVe rule for hospitalisation in BIOTOPE was found to be 0.80 (95% C.I of 0.75-0.85). The AUC of STARWAVe for a confirmed diagnosis of bacterial pneumonia was 0.39 (95% C.I 0.25-0.54). Interpretation: This review highlights the lack of clinical prediction rules in this area. The STARWAVe rule identified was useful in predicting hospitalisation from bacterial infection as defined. However, in the absence of a gold standard indicator for bacterial LRTI, this is a reasonable surrogate and could lead to reductions in antibiotic prescription rates, should clinical impact studies prove its utility. Further work to determine the clinical impact of STARWAVe and to identify diagnostic tests for bacterial LRTI in primary care is required.

identify content preferences for an educational video; d) and what to include in a question prompt list. All focus groups were audio-tape recorded and transcribed. Identifiers were removed and replaced with a numerical code. The qualitative analysis software package NVivo version 11.0 assisted in the data analysis. Ethical approval was obtained from the two relevant ethics committees.The data from the focus groups will inform the development of the intervention (video and question prompt sheet) which is based on Bandura's Social Cognitive Theory, as selfefficacy is a central component of SCT. Self-efficacy is the belief that an individual has the ability to create change by personal actions. Enhanced diabetes self-efficacy has been linked to improved diabetes self-management and glycaemic control and is an important indicator of health behaviour changes in adolescents. The issues which arose from the focus groups will be outlined and discussed in terms of self-efficacy and development of the intervention.