Background: The inability to ensure adequate nutrition for patients, and failure to provide adequate calorie and protein intake, result in malnutrition, leading to increased morbidity and mortality. The present study assesses the two approaches to enteral nutrition—intermittent and continuous enteral feeding—in critically ill pediatric patients in Türkiye to determine the superiority of one method over the other. Methods: Included in this multicenter prospective study were patients receiving enteral nutrition via a tube who were followed up over a 3-month period. Anthropometric data, calorie and protein intake, and signs of feeding intolerance were evaluated in a comparison of the different feeding methods. Results: A total of 510 patients were examined. In the continuous enteral feeding (CEF) group, 20.2% of patients developed metabolic abnormalities, and 49.5% experienced enteral nutrition intolerance, both of which were higher than in the intermittent enteral feeding (IEF) group, and the differences were statistically significant. No significant differences were observed between the two feeding methods in terms of reaching the target calorie intake on days 2 and 7 (p > 0.05). On day 7, there were significant differences between the two feeding methods in terms of calorie and protein intake (p = 0.023 and 0.014, respectively). Conclusions: In the present study, assessing the IEF and CEF approaches to enteral nutrition, critically ill pediatric patients receiving intermittent feeding exhibited lower rates of enteral nutrition intolerance and metabolic abnormalities. Furthermore, the calorie and protein intake on day 7 were noted to be higher in the IEF group than in the CEF group. Further randomized controlled trials are needed to confirm the findings of the present study.

Pediatric exanthematous diseases pose diagnostic challenges because clinical presentations overlap. To determine whether current artificial intelligence (AI) models achieve diagnostic accuracy within or above the performance distribution of pediatric residents and specialists for common rash-associated diseases. Participants and AI models were evaluated against definitive diagnoses confirmed by clinical features, laboratory findings, and consensus of two pediatric infectious disease specialists. A volunteer sample of 263 pediatric clinicians: 107 residents (years 1 through 4) and 156 specialists. Each clinician completed a blinded multiple-choice questionnaire with a clinical photograph and accompanying clinical data per case. The same cases were presented to three AI models: ChatGPT, Gemini, and Copilot. Among 263 clinicians (107 residents, 156 specialists), specialists scored higher than residents (median, 46 [IQR, 42—50] vs 41 [IQR, 36—46]; P < .001; r = 0.32). ChatGPT correctly diagnosed 53 of 61 cases (86.9%), Gemini 50 (82.0%), and Copilot 44 (72.1%). Both ChatGPT and Gemini exceeded the upper bound of the specialist population median 95% CI (47.17). All three AI models scored above the resident 95% CI upper bound (42.76). Disease-level accuracy ranged from 0% (insect bites, all models) to 100% (9 conditions, all models). Fourth-year residents scored higher than first- and second-year residents ( P = .001; ε ² = 0.13). Conclusions : AI models given clinical data alongside images matched or exceeded specialist-level performance for pediatric exanthems. Accuracy varied by disease; failures clustered in conditions that require contextual reasoning. Physician oversight remains necessary where AI accuracy is lowest. What is Known • Childhood exanthematous diseases pose significant diagnostic challenges due to their overlapping clinical presentations. • Artificial intelligence models are becoming increasingly proficient in accurately diagnosing these conditions. What is New • In this diagnostic accuracy study of 61 cases evaluated by 263 clinicians and 3 artificial intelligence models, ChatGPT (86.9%) and Gemini (82.0%) exceeded the 95% CI upper bound of the specialist population median. Disease-level accuracy ranged from 0 to 100% across models • Artificial intelligence models given clinical data alongside images can match or exceed specialist-level accuracy for common pediatric exanthems, but failures in context-dependent diagnoses require physician oversight

AMAÇ: Çocukluk çağı zehirlenmeleri önemli bir halk sağlığı sorunudur. Zehirlenme vakaları yıllar içinde ailelerin bilinçlenmesi, tıbbi gelişmeler gibi faktörlerle yıllar içinde farklılık gösterebilmektedir. Bu konuda yapılan çalışmalar hastaların hem tanı hem de tedavilerine ışık tutmakta hem de hasta mortalite ve morbiditesi olumlu yönde etkilenmektedir. Biz de bölgesel zehirlenme profilimizi belirlemek, erken tanı ve tedavi yaklaşımları konusunda farkındalığı artırmak amacıyla bu çalışmayı planladık. YÖNTEM ve GEREÇLER: Ocak 2016 ve Mayıs 2020 tarihleri arasında, hastanemiz çocuk acil servisine başvuran ve zehirlenme tanısıyla izlenen 472 vakanın klinik ve epidemiyolojik özellikleri hastane kayıtları üzerinden tarandı ve incelendi. BULGULAR: Acil servise başvuran 472 zehirlenme vakasının %47.3’ü kız, 52.7’si erkekti. Zehirlenme etkeninin alım yolunun %87.1 ile enteral olduğu, %12,9’nun inhalasyon yoluyla zehirlendiği belirlendi. Majör zehirlenme etkeninin kostik veya koroziv maddelerin olduğu (%42,8), bunu ilaçların takip ettiği görüldü (%30,5 ). 0-12 ay ve 13-48 ay çocuklarda kaza sonucu majör zehirlenme etkenin kostik/koroziv maddeler ( %48 ve %33,7) olduğu, 49 ay-13 yaş çocuklarda ise kaza sonucu majör etkenin ilaç dışı maddeler (%32,5) olduğu belirlendi. 13 yaş üzeri çocuklarda majör etkenin ilaçlar olduğu (%18,1) saptandı. 0-12 ay (%42,4) ve 13 yaş üzeri (%21,3) çocukların zehirlenme oranlarının pandemi esnasında, öncesine kıyasla anlamlı derecede arttığı belirlendi. 13-48 ay (%22,7) ve 49 ay-13 yaş (%13,6) çocukların zehirlenme oranlarının ise pandemi öncesine kıyasla anlamlı derecede düştüğü saptandı. SONUÇLAR: Çocukluk çağı zehirlenmeleri nadir bir sağlık sorunu değildir. Zehirlenmenin önlenmesi için erken başvuru ve ön müdahale konusunda toplumun eğitilmesi önem arz etmektedir. Bölgemizin zehirlenme profilini çıkardığımız bu çalışmanın, zehirlenme vakalarında erken teşhis ve alınacak gerekli tedbirlere katkı sunacağını düşünmekteyiz.

In our country, a considerable number of athletes are under the age of 18, and concerns regarding their physical, psychosocial, and athletic development are increasingly prominent. In the US, Pediatric Sports Medicine (PSM) , which has yet to be established in Turkey and many European countries, deals with the care and monitoring of young athletes. This study aimed to explore the challenges pediatricians face during preparticipation evaluation (PPE) of young athletes, the difficulties encountered in managing this specific population, and their perspectives on how the establishment of a PSM division could contribute, particularly in addressing legal responsibilities. An online questionnaire was comprised of 12 questions, which addressed participants' personal and professional features, as well as which specialties pediatric athletes were mostly referred, types of sports of pediatric athletes, challenges experienced with the athlete and his/her parents during PPE, their awareness on PSM fellowship abroad, and their opinions on interests of PSM and establishment of PSM in our country. A total of 360 pediatricians were recruited. Of the participants, 89.7% reported challenges with parents due to requesting immediate issuance of reports and 52.2% due to requesting reports without the child being present. Of the participants, 69.2% had never heard about PSM. Of the participants, 83.3% stated that establishment of PSM in Turkey would definitely make contribution, and 73.9% stated that PSM should definitely be established. Awareness of PSM is low among pediatricians. The establishment of PSM in Turkey is widely supported and considered to be beneficial.

Background: Bronchiolitis is the most common lower respiratory tract infection, with the most commonly isolated organism being respiratory syncytial virus (RSV). Despite several studies on intestinal permeability in various acute and chronic pulmonary diseases, studies examining these molecules in patients diagnosed with bronchiolitis are very limited. This study was conducted to examine zonulin and claudin‐3 levels to evaluate intestinal permeability in children diagnosed with bronchiolitis. Materials and Methods: A total of 98 children, 60 patients with bronchiolitis and 38 healthy controls were included in this study. After informed consent of patients and their parents were obtained, 5 mL of blood serum samples were collected upon admission, after confirmation of the diagnosis, which were kept frozen until being analyzed for zonulin and claudin‐3 levels and subsequently analyzed and compared between the groups. Results: The median value of zonulin was 18.57 ng/mL in the patient group and 12.41 ng/mL in the control group. There was no significant difference in zonulin levels between the patient and control groups ( p = 0.540). The mean claudin‐3 (CLDN3) level was significantly lower in the patient group (3889.56) than the control group 4216.77 ( p < 0.001). In the patient group, zonulin and claudin levels did not significantly differ by the need of mechanical ventilation and ICU administration ( p > 0.05). Conclusion: In conclusion, CLDN3 levels were found to be significantly lower in patients with bronchiolitis than in the control group. This finding may indicate that low CLDN3 levels may be involved in pathogenesis of bronchiolitis, by impairing airway permeability Further studies with larger number of participants, investigating the effect of airway permeability on the pathogenesis of bronchiolitis, which compare zonulin and CLDN3 levels according to disease severity, are warranted.

Objective: There are numerous athletes under 18 years of age in our country, whose physical, psychosocial and athletic developments have become more of an issue. The aim was to determine challenges confronted by coaches of pediatric athletes in the referral of pediatric athletes for preparticipation medical clearance, management of injuries, pre- and postparticipation follow-up, and opinions of coaches about whether establishment of Pediatric Sports Medicine (PSM) would be warranted. Materials and Methods: This questionnaire addressed coaches’ age, sex, the sport branch they were dealing with, physicians to whom they refer pediatric athletes, challenges experienced with the athlete and his/her parents during preparticipation evaluation (PPE), challenges experienced by parents during PPE, suggested branch for referral, awareness of coaches on PSM abroad, and their opinions on interests of PSM and establishment of PSM in our country. Results: A total of 352 coaches were included. The most common branch of coaching was football (21.4%). The most common physicians they were referring to were sports medicine specialists (52.0%), family medicine specialists (44.9%), general pediatricians (33.8%), and pediatric cardiologists (29.3%). Of the participants, 69.0% had never heard about PSM. Regarding areas of interest of PSM, 55.1% stated they had no idea, 37.5% routine follow-up and 25.0% physical examination of pediatric athletes. Of the participants, 90.1% stated that establishment of PSM in our country would definitely contribute to PPE, and 94.9% stated that it should definitely be established. Conclusion: It was concluded that awareness on PSM is low among coaches and that the establishment of PSM would definitely make contribution in Türkiye. Cite this article as: Akkuş A, Aslan H, Özkaymakoğlu C, et al. Challenges confronted by coaches in evaluation of pediatric athletes: Awareness on pediatric sports medicine. Turk Arch Pediatr. 2025;60(3):314-318.