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. 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.

Articles

In this episode, the panel discusses therapies and care around inpatients including mechanical ventilation, extracorporeal membrane oxygenation (ECMO), and remdesivir.

COVID-19 Therapy Roundtable:  Focusing on Inpatient Care 

Pharming Group N.V. plans to include these findings in worldwide regulatory filings in 2025. 

Leniolisib: positive phase 3 data in children aged 4 to 11 years with APDS

A good correlation and statistical agreement with total serum bilirubin was observed in a study of a new smartphone-based machine learning app, leaving it a potential neonatal jaundice screening tool. 

Using a smartphone application to screen for neonatal jaundice

In the study through 76 weeks, no new risks were observed with once-daily upadacitinib (15 mg or 30 mg). 

Upadacitinib effective in treating atopic dermatitis through 76 weeks

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Pediatric adolescent gynecologic topics are critical to the practice, and patient families.



The world of the pediatric adolescent patient

**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

® website. Take a look at some of our top stories from last week (Monday, December 2, to Friday, December 6, 2024), and click on each link to read and watch anything you may have missed.

COVID-19 Therapy Roundtable: Defining the Virus Today and Treatment Options

Click the link below and watch our first episode of our COVID-19 Therapy Roundtable discussion, in collaboration with our sister publications 

. Our panels of experts highlight different therapies around COVID-19 treatment and prevention, and offer practical clinical pears surrounding the infectious disease.

Tina Tan, MD, professor of Pediatrics, Feinberg School of Medicine, Northwestern University 

Scott Roberts, MD, associate medical director of Infection Prevention, Yale School of Medicine

James Wilson, DO, FACP, FAWM, CTropMed, critical care physician in private practice 

Michael Curulewski, PharmD, BCPS, BCIDP, BCGP infectious diseases and antimicrobial stewardship pharmacist, Endeavor health, Northwest Community Hospital 

Our next episode of this roundtable series will be posted Wednesday, December 11 on 

Click here to watch the first episode, which runs 11 minutes.

Fremanezumab for episodic migraine prevention demonstrates positive phase 3 data 

Teva Pharmaceuticals has reported positive phase 3 results for fremanezumab (Ajovy) in preventing episodic migraine in children and adolescents aged 6 to 17 years. The SPACE trial (NCT04530110), a 12-week, randomized, placebo-controlled study, demonstrated significant efficacy compared to placebo and a safety profile consistent with adult populations. 

Key findings include a reduction in monthly migraine days (-2.5 vs -1.4; P = 0.0210), monthly headache days (-2.6 vs -1.5; P = 0.0172), and a higher proportion of patients achieving a ≥50% reduction in migraines (47.2% vs 27.0%; P = 0.0016). Benefits were consistent across age groups and genders. The safety profile was favorable, with adverse event rates comparable between fremanezumab (55%) and placebo (49%), and low discontinuation rates (≤1%).

This milestone addresses the rising incidence of pediatric migraines, which affects up to 15% of adolescents but has seen limited innovation in treatment options. Fremanezumab, already approved for adult migraine prophylaxis, is the first CGRP-pathway treatment to demonstrate statistically significant efficacy and safety for episodic migraine prevention in pediatric patients. Further studies are ongoing to assess its use in chronic migraines and long-term safety. 

FDA grants Rare Pediatric Disease to 101-PGC-005 for systemic juvenile idiopathic arthritis

PIF Partners has announced that its investigational therapy 101-PGC-005 ('005) has received Rare Pediatric Disease Designation from the FDA for systemic juvenile idiopathic arthritis (sJIA) flares. The treatment, a Type IA prodrug of dexamethasone targeting CD206+ macrophages, is also undergoing phase 3 trials in India for COVID-19-induced acute respiratory distress syndrome.

Systemic juvenile idiopathic arthritis is a rare, severe autoinflammatory disease affecting children under 16, characterized by spiking fevers, rash, joint inflammation, and organ involvement. The FDA's designation promotes the development of treatments for serious pediatric diseases, reflecting '005's potential to address the unmet needs in sJIA. 

In a study that assessed 3 randomized clinical trials of adolescents with moderate-to-severe atopic dermatitis (AD) who were treated with upadacitinib, results demonstrated sustained efficacy responses through 76 weeks to go along with a favorable safety profile. These results were published in 

In the Measure Up 1 (NCT03569293), Measure Up 2 (NCT03607422), and AD Up (NCT03568318) trials—ongoing, double-blind, placebo-controlled phase 3 randomized clinical trials featuring adolescents aged 12 to 17 years with moderate to severe AD—once-daily upadacitinib, 15 mg or 30 mg, was superior to placebo alone (Measure Up 1 and Measure Up 2 trials) or with topical corticosteroids (AD Up trial) through 16 weeks, and was sustained through 52 weeks during blinded extension phases of the studies.

To further evaluate the once-daily JAK inhibitor, the study investigators sought to assess the efficacy of upadacitinib, 15 mg and 30 mg, with or without topical corticosteroids, in the same patient population through 76 weeks.

Click here for study results and full data points.

J&J submits applications for guselkumab to treat plaque psoriasis, jPsA in children

A pair of supplemental Biologics License Applications (sBLAs) have been submitted to the FDA for Johnson & Johnson's guselkumab (Tremfya) to treat moderate-to-severe plaque psoriasis (PsO) in children aged 6 years and up and to treat active juvenile psoriatic arthritis (jPsA) in children aged 5 years and older, Johnson & Johnson recently announced.

According to the announcement, the PsO submission is backed by data from the phase 3 PROTOSTAR study (NCT03451851) that featured pediatric patients with moderate-to-severe plaque PsO. In addition, the submission is based on bridging pharmacokinetic (PK) data from the phase 3 Voyage 1 (NCT02207231) and Voyage 2 (NCT02207244) studies in adult patients.

Get caught up with Contemporary Pediatrics! This list helps you navigate our top stories from the week, all in one place. 

News

Weekly review: COVID-19 roundtable, upadacitinib data for AD, and more

In case you blinked and missed it, 2024 is winding down, and the holiday season looms. For many, the annual procession into revelry, reflection, and reunions is comforting. It is also a time when self-care can be disrupted. 

The concepts of holiday-related anxiety and depression are not foreign to anyone, but their reach and effect are staggering all the same. 

Approximately 9 in 10 adults described event-specific anxiety during the holiday season to the American Psychological Association.

Another 4 in 10 stated that their stress increases during the holidays. Paradoxically, only 7% of surveyed adults felt their stress decreases during this time.

The mental health burden of this period can lead to a worsening of chronic conditions, an increased risk of suicidal behavior, and setbacks in care of other mental illnesses. 

The holidays are also infamously a stressor on individuals’ diets; research shows sedentary behavior and overeating are holiday traditions. One study suggests individuals may consume up to 6000 calories on Christmas Day—a 3-fold increase in the recommended daily allotment.

Individuals are putting themselves at greater risk of gastric and cardiometabolic disease and even major adverse cardiovascular events. 

Despite our earnest efforts to make the most of our holiday celebrations, it is clear we may still be compromising our health. How do we break a tradition of setbacks born from more unhealthy traditions? 

For caregivers, the solution may be as simple as an honest conversation with their patients. What are their holiday traditions? What are their stressors and their drivers of anxiety? What are their resolutions for the New Year, and how can you help them achieve their health-related goals? 

It does not hamper the inherent joy of our holidays to concede that they can take their toll. It only equips patients to consider healthier decisions and to prioritize the means of self-care during a time when everyone should be feeling their best.

1. Even a joyous holiday season can cause stress for most Americans. News release. American Psychological Association. November 30, 2023. Accessed October 24, 2024. https://www.apa.org/news/press/releases/2023/11/ holiday-season-stress 

2. Simple tips to curb overeating can help prevent weight gain at Christmas. News release. Loughborough University. December 11, 2018. Accessed October 24, 2024. https://www.lboro.ac.u. 

Mike Hennessy Jr. shares his thoughts on the holiday health paradox.

Opinion

Navigating the holiday health paradox

Paul Kruszka, MD, MPH, FACMG, explains for general providers the difference between screening and diagnosis regarding whole genome sequencing and how it could play a role in the primary care setting. 

Whole genome sequencing: Screening and diagnosis

Paul Kruszka, MD, MPH, FACMG, chief medical officer of GeneDx and clinical geneticist at Children’s National Hospital, discussed the role of genetic testing in pediatric care.

“[If] a general pediatrician is seeing a child with a congenital anomaly, global developmental delay, intellectual disability, epilepsyreally, those are children that need genetic testing,” Kruszka explained. He emphasized that exome and genome sequencing are now recommended as first-tier tests for these conditions, as established by the American College of Medical Genetics in 2021. Additionally, “The American Epilepsy Society has endorsed guidelines for exome or genome for any individual of any age with unexplained epilepsy.” 

Rapid genome sequencing is also becoming a key diagnostic tool in neonatal intensive care units (NICUs). “Critically ill children in an ICU environment should be also getting rapid testing,” Kruszka noted, pointing to a growing body of evidence supporting this approach. He stressed that these tests offer high diagnostic yields, stating, “Professional guidelines support it. And most important, the payers are paying for it.” 

Kruszka acknowledged the challenges of payer coverage but highlighted progress in accessibility. “Most of what we do at my company at GeneDx is public payers, is Medicaid, state Medicaid programs. I think roughly 40% of children in the US have Medicaid insurance,” he explained. Over half of GeneDx’s testing is supported by Medicaid, marking significant advancement in making genetic testing available to more families. 

The impact of genetic diagnoses extends beyond the clinical realm, profoundly affecting families, Kruszka has found. 

“Once you make that diagnosis, that changes everything for the family,” Kruszka said. “[If nothing else], the parents stop feeling guilty." 

Kruszka highlighted the importance of patient advocacy groups in supporting families and disseminating information about rare conditions. “Usually…a patient who has a diagnosis, who’s done their own research, who’s a member of patient advocacy groups, will know more about the disease than most providers or physicians,” he said. 

Ultimately, genetic testing not only ends the “diagnostic odyssey” for families but also equips them with critical resources and community support, enhancing the quality of pediatric care, according to Kruszka.

Paul Kruszka, MD, MPH, FACMG, has the following disclosures

Employment - Chief medical officer at GeneDx

In a separate video interview, Kruszka provided further background of whole genome sequencing in primary care. 

Paul Kruszka, MD, MPH, FACMG, explains for general providers the difference between screening and diagnosis regarding whole genome sequencing and how it could play a role in the primary care setting.

Catherine Y. Spong, MD

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