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Nicholas P. Marshall, MD, FAAP, Fellow - Pediatric Infectious Diseases and Clinical Informatics Stanford University, Palo Alto, CA, United States. 

Articles

. He joined the brand in March of 2023 as an editor before being promoted to senior editor in January 2024. Fitch graduated from Youngstown State University in Youngstown, Ohio in 2020 with a degree in telecommunications and journalism. He started his career as a news and sports videographer before becoming an on-air sports anchor at the NBC-affiliated news station in Youngstown. Fitch briefly worked as a national content writer for a Chicago-based national television station before joining the 

team. He can be reached at: jfitch@mjhlifesciences.com.

Nicholas P. Marshall, MD, FAAP, discussed how generative AI can help streamline infectious disease workflows and enhance evidence-based care at IDWeek 2025 in Atlanta.

Practically expanding AI's role in infectious diseases, with Nicholas Marshall, MD, FAAP

Yohei Doi, MD, professor of Medicine and director of the Center for Innovative Antimicrobial Therapy at the University of Pittsburgh and professor of Microbiology and Infectious Diseases at Fujita Health University

Yohei Doi, MD, IDWeek chair, Infectious Diseases Society of America, provides some insights on the happenings at this year’s event from Atlanta, Georgia.

Yohei Doi, MD, highlights education, networking, and scientific sessions at IDWeek 2025

 and joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio before joining 

 You can reach her at mpetronelli@mjhlifesciences.com.

Children born preterm face significantly reduced odds of completing high school and university compared with full-term peers.

Preterm birth linked to reduced odds of high school graduation

* Generic lenacapavir could be produced for $25 per person per year at scale, according to an analysis presented at IDWeek 2025 in Atlanta. 

IDWeek: Generic lenacapavir could cost as little as $25 per person annually

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An 11-year-old boy with a history of asthma and allergic rhinitis presented to the emergency department (ED) with worsening fatigue, minimal responsivity to external stimuli, and diffuse muscle weakness for 2 months.

Boy presents with fatigue, minimal responsivity, and diffuse muscle weakness

**Editor's Note** Please note that starting January 1, 2025, we will be switching to an online-exclusive publication process. This will allow us to publish case submissions quicker without having to deal with the variables that come along with print publication. All cases will still be eligible for print publication consideration, but publication in our print magazine is not guaranteed and will be up to the editor's discretion. 

Do you have a puzzling pediatric case that you’d like to share with the readers of 

We are looking for intriguing diagnoses that have stumped the experts—a diagnostic “Puzzler”—to help our physicians enhance their day-to-day practices. If you have such a story to tell, tell us.

Here’s what to do: Before you begin, we suggest that first you review the Puzzler 

https://www.contemporarypediatrics.com/case-studies

. Please note the specific style required for writing Puzzler manuscripts.

Next, prepare a draft of your case, including a summary of the presenting symptoms, a case overview, a 

table of the differential diagnosis (MANDATORY)

, and the special aspects of your case that qualify it as a Puzzler, and send it to us. Please note that the differential diagnosis table should also be discussed in the body text. We’ll review your draft and let you know what you need to add or revise before we send the manuscript to peer review for evaluation.

Puzzlers vary in length, and we suggest a minimum of 1,200 words up to a maximum of 2,000 words, but that is because of the complexity of some cases and whether some patients returned for many assessments before their diagnoses were determined. Also, some authors describe the pathophysiology of the differentials in great detail. Please also note no more than 3 authors are allowed per article.

What's most important is to show us the process that you used to analyze the case, including:

Why you decided to order certain tests and why you did not order others.

Peer consultations or why you elected to contact other specialists.

Lab values including vital signs or blood tests.

Labs and values if your patient was attended to in the emergency department or other hospital departments such as radiology or neurology.

Discussion related to the possible diagnoses.

Final diagnosis, treatment, prognosis, and follow-up.

Remember to indicate numbered citations within the body of the text and include a complete list of corresponding literature/references at the end of the manuscript. (Do not use any citation management programs or unlink them.) 

Limit references to 25. No references (unless it is a seminal study) can be older than 10 years.

We prefer primary research as references, but some cases are so obscure that authors will need to pull from a variety of sources. However, 

. Be advised that peer reviewers are adamant that the disease/disorder you describe was actually diagnosed and not determined by index of suspicion on the basis of ruling out various differentials. We use AMA11 as our publication style, which uses superscript citation numbers and a corresponding numbered reference list. Please create your citations and references in this style.  Check this recent article posted online at 

https://www.contemporarypediatrics.com/view/the-rx-of-adhd

 for examples of reference style. IMPORTANT NOTE WITH AMA 11TH EDITION: PLEASE PUT DOI OR WEBSITES/URLS AT THE END OF THE REFERENCE LINE.

When you send your draft manuscript, also 

. These image files must be high-resolution jpg or tiff files (minimum of 300 dpi) and as large in size as possible. We suggest a minimum of 7 horizontal inches. The images must be original photos with clear permissions to use, not images from copyrighted sources. Send as separate attachments with your e-mail submission; do not embed images into your manuscript document.

After we receive your manuscript, our editors and peer reviewers will review your draft and let you know if we accept your submission for publication. 

Puzzler is one of the departments for which we receive the most submissions, so it may be several months after submission before you receive feedback from us.

If we do accept your submission for publication, we will contact you with further instructions.

Send your submissions in Microsoft Word format to 

, via e-mail to mpetronelli@mjhlifesciences.com

Guidelines for PUZZLER, Contemporary Pediatrics

 poll. Take a look at the following case below. After reading through the description, choose a multiple-choice answer and try to guess the correct patient diagnosis.

This case was presented by Rutva Vora, BS; and Monica Guirguis, DO.

A 2-month-old girl was born after an uneventful pregnancy at 40 weeks’ gestation via vacuum-assisted vaginal delivery to a G2P1011 female. The patient’s APGAR scores were 7 and 9 at 1 and 5 minutes, respectively, at birth. No bleeding or other complications were reported during delivery. The newborn and mother were discharged two days after delivery without requiring neonatal intensive care unit stay or interventions. The infant briefly developed a small soft palpable scalp swelling that resolved within days after delivery. The patient followed an otherwise uncomplicated growth progression since birth. She did exhibit mild reflux symptoms, which were managed with supportive care measures. Physical examination after delivery and subsequent exams revealed no abnormalities, including no signs of scalp swelling or injury.

At 8 weeks of age, the patient presented to the emergency department with a 3-day history of new-onset scalp swelling. The parents decided to seek medical attention after the swelling became noticeably enlarged. Parents denied any changes in her mental status, vomiting, fevers, lethargy, irritability, or any other new concerns. She did have symptoms of gassiness and fussiness that were unchanged from baseline. No history of trauma was reported, and there were no concerning signs suggestive of nonaccidental trauma. The patient appeared well, with a soft, fluctuant palpable subcutaneous fluid collection overlying the parieto-occipital scalp, without crossing suture lines. The anterior fontanelle was soft and nonbulging, and there was no hemotympanum.

Bleeding disorder (e.g. Von Willebrand Disease)

Can you diagnose this patient? Take our poll and find out! Then check back for the full case, differential diagnosis, and correct diagnosis.

Case Studies

Diagnose this 2-month-old with scalp swelling

At CNS 2025, Kathryn Xixis, MD, highlighted the growing adoption of EPAs and outcomes-based learning in pediatric neurology.

Kathryn Xixis, MD, on developing EPAs for child neurology training

At the 2025 Child Neurology Society (CNS) Annual Meeting in Charlotte, North Carolina, Kathryn Xixis, MD, associate professor of pediatrics at the University of Virginia, discussed how competency-based medical education is transforming the evaluation of medical trainees in child neurology and beyond.

Defining the Outcome: Developing EPAs for Child Neurology Training

, where she outlined how this model moves away from traditional, time-based training to focus instead on measurable competence and readiness for independent practice.

Shifting from time-based to outcome-based education

“We are in a period of major change in how we assess medical trainees,” Xixis said. “Competency-Based Medical Education represents a new era, shifting the focus from time-based measures to outcomes-based assessment.”

The CBME model challenges the assumption that completing a fixed number of years in training equates to clinical competence. Instead, it asks whether learners have demonstrated the knowledge, skills, and judgment required for independent practice at the time of graduation.

Defining measurable outcomes tied to clinical competence

Implementing Entrustable Professional Activities (EPAs) as performance benchmarks

Providing structured, real-time feedback to support learning

How to create feedback and accountability in pediatric neurology training?

While the concept of EPAs was introduced in 2005, Xixis noted that its adoption has accelerated across medical specialties over the past decade. In child neurology, ongoing efforts are focused on developing specialty-specific EPAs that align with clinical practice and educational milestones.

She emphasized that immediate, formative feedback plays a central role in improving performance and reinforcing accountability. “That immediate, actionable feedback is at the heart of CBME,” she said. “It ensures that, upon graduation, all physicians meet a clear and consistent standard of competence.”

According to Xixis, competency-based approaches not only strengthen medical education but also enhance public trust by ensuring every new physician is prepared to deliver safe, high-quality care.

Xixis K. Defining the Outcome: Developing EPAs for Child Neurology Training. Symposium. Presented at: 2025 Child Neurology Society Annual Meeting. October 7-11, 2025. Charolotte, North Carolina. 

News

At the 2025 CNS Annual Meeting, Craig Press, MD, PhD, discussed challenges in achieving equitable access to diagnostics and expertise in pediatric neurocritical care.

Craig Press, MD, PhD, highlights challenges in pediatric precision care for epilepsy

At the 2025 Child Neurology Society (CNS) Annual Meeting in Charlotte, Craig Press, MD, PhD, associate professor of clinical neurology at the University of Pennsylvania and medical director of the Neuroscience Unit at Children’s Hospital of Philadelphia, discussed the growing need for expanded access to genetic testing and multidisciplinary expertise in pediatric neurocritical care.

Press presented during the session “Bringing Precision Therapy to the Neurocritical Care Bedside,” part of Seminar 7: 

Optimizing NeuroICU Care: Treating Patients Rather Than Seizures.

 His presentation highlighted how evolving diagnostic tools and data-driven strategies are helping clinicians better tailor treatments to the individual needs of children experiencing neurologic crises.

“In children who present with early epilepsy, we often need genetic testing to better understand the underlying cause,” Press said. “The timeframe to receive those results can still take weeks to months, although rapid genetic tests are available. However, they aren’t accessible at every institution or for every patient. Expanding access to these tests will be critical.”

According to Press, limited availability of rapid genetic testing can delay diagnosis and timely therapeutic decisions in acute pediatric cases. Increasing access to these resources across institutions could help shorten diagnostic timelines and improve precision treatment planning.

Expanding institutional access to rapid genetic testing platforms

Reducing turnaround times for results to improve clinical decision-making

Ensuring equitable access for all pediatric patients regardless of location

Building expertise across the care continuum

Press also emphasized the importance of training clinicians to interpret and apply emerging diagnostic tools, including EEG and immunologic biomarkers. “This isn’t a skill set that most clinicians learned in medical school, residency, or fellowship,” he said. “Figuring out how to extend that expertise across institutions and build multidisciplinary teams to answer these questions—and bring all those resources to bear at the right time—is one of our biggest needs.”

He added that professional organizations such as the Child Neurology Society and the American Epilepsy Society have started offering educational programs focused on precision medicine in pediatric neurology. Still, Press noted that meaningful progress will depend on continued investment in training, resources, and collaboration to ensure that precision therapies reach every child who may benefit.

Press C. Bringing Precision Therapy to the Neurocritical Care Bedside. Presented at: 2025 Child Neurology Society. October 8-11. Charlotte, North Carolina. 

Craig Press, MD, PhD, discussed the evolution of pediatric neurocritical care toward individualized, evidence-based approaches that move beyond seizure suppression to holistic patient care.

Craig Press, MD, PhD, on bringing precision medicine to pediatric neurocritical care

As precision medicine reshapes pediatric neurology, clinicians are working to personalize treatments for children facing life-threatening neurologic crises. At the 2025 Child Neurology Society (CNS) Annual Meeting in Charlotte, North Carolina, Craig Press, MD, PhD, associate professor of clinical neurology at the University of Pennsylvania and medical director of the Neuroscience Unit at Children’s Hospital of Philadelphia, discussed how data-driven approaches are redefining how clinicians manage seizures, inflammation, and critical neurologic disease at the bedside.

Press presented during the session “Bringing Precision Therapy to the Neurocritical Care Bedside,” part of Seminar 7: Optimizing NeuroICU Care: Treating Patients Rather Than Seizures

 The program explored novel pharmacologic and immunologic strategies—such as ketamine, ganaxolone, and cytokine-targeting therapies—and how integrating quantitative electroencephalography (EEG) and genetic testing can tailor interventions to each child’s unique etiology.

Rethinking seizure and inflammation management

“The biggest goal here was, when we think about neurocritical care and pediatric patients, there’s a lot of variety in the kids that we take care of,” Press said. “Each individual patient may respond differently to these therapeutics, or they may need a different diagnostic path.”

Press emphasized that although care pathways serve most patients, others—such as those experiencing new-onset refractory status epilepticus—require rapid diagnostics and customized intervention. “They need rapid genetic testing and new quantitative ways of looking at their EEG in response to therapies so that we can better target the underlying causes,” he said.

Press highlighted several promising treatments under study, including 

, noting that although ganaxolone’s recent trial did not meet all primary end points, “there were some exciting signals that suggest there may be ways this drug could be used.”

 to monitor real-time treatment response 

Craig Press, MD, PhD, discussed the evolution of pediatric neurocritical care toward individualized care at the 2025 Child Neurology Society meeting. 

Brian Chang, MD, MS

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