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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.

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 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.

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

Weekly review: ACIP meets and votes, marstacimab data for hemophilia, and more

Mercedes E. Gonzalez, MD, board-certified pediatric dermatologist, a clinical assistant professor at the FIU Herbert Wertheim School of Medicine and the Phillip Frost Department of Dermatology at the Miller School of Medicine; Medical Director at Pediatric Skin Research, Miami, Florida.

Roflumilast cream 0.05% is being studied for mild-to-moderate AD in infants aged 3 months to under 2 years in a new phase 2 trial.

Mercedes Gonzalez, MD, discusses phase 2 trial of roflumilast cream 0.05% for infant atopic dermatitis

New phase 3 data support marstacimab’s efficacy and safety in treating hemophilia A or B with inhibitors, expanding its potential use.

Marstacimab reduces ABR in patients 12 years and up with hemophilia A or B with inhibitors

Mycoplasma pneumoniae caused 1 in 2 pediatric pneumonia hospitalizations in 2024, with sharp increases seen across all age groups, according to a recent CDC MMWR report. 

Surge in pediatric Mycoplasma pneumoniae hospitalizations reported in 2024

Contemporary Pediatrics connects pediatricians with peer-reviewed articles, guideline updates, and practice strategies for real-world clinical application.

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Authors

 On examination, the left testicle was noted to be much smaller than the right. There was no change in color, and the testicle was firm and nontender. The physical findings were otherwise unremarkable. 

Neonatal Testicular Torsion

**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 Giridhar Guntreddi, MD FAAP, FAPHM; Achuth Jayasankar Kondoor, Taylor Boske, Neelima P. Theella, MD, and Jayasree Vasudevannair, MD MPH FAAP. 

A healthy 12-month-old girl presented with one small skin lesion over the right heel (Image 1) for one month. On examination, her right lateral heel showed a round, white, pearl-like, hard, tiny lesion with a smooth appearance without any redness or itching. The patient's mother denied any pain, swelling, itching or fever. No significant travel, bites, heel stick injuries were reported in the history. No systemic symptoms suggested any underlying systemic diseases. The infant is closely monitored at subsequent well visits and re-checked. After 3 months, the child showed full resolution of the skin lesion over the heel area (Image 2).

Below, take your best guess at diagnosing this patient.

click here for the full case presentation, differential diagnosis, and correct patient diagnosis. 

Thank you for taking this Contemporary Pediatrics poll! Want more puzzler case studies? 

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

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Case Studies

Diagnose this infant with an asymptomatic pearl-like nodule on the heel

Pediatric dermatologist John Browning, MD, offers practical sun safety tips and guidance for selecting sunscreens, emphasizing the importance of choosing formulations that work for sensitive skin.

John Browning, MD, provides practical skincare reminders ahead of summer season

As summer approaches, pediatric dermatologist John Browning, MD, Chief of Dermatology at Children’s Hospital of San Antonio is reminding families to stay vigilant about sun safety, especially for children and those with sensitive skin. 

“As always during the summertime, I'd like to remind everybody to wear your sunscreen and stay protected and be smart when you're outside,” Browning said. “And of course, if you do have sensitive skin, be sure to take care of it. Moisturize with a 

, and don't forget to see your dermatologist if needed.” 

When it comes to choosing the right sunscreen, Browning compared the process to picking a toothpaste or shampoo, as there are many options, and several can be appropriate depending on the individual. 

“Most dermatologists would agree with me… there's lots of good choices out there,” he said. “You do want to look for something that's going to be SPF 30 or higher. It's usually pretty easy to find 50 or higher. It should say broad spectrum, UVA and UVB, and water resistant up to 80 minutes.”

Browning also emphasized the advantages of mineral sunscreens over chemical options, particularly for individuals with sensitive skin.

“In general, I think we would all agree that the physical blockers are better,” he said. “Those are the ones that have zinc oxide and titanium dioxide in it. And that's because those physical blockers will actually scatter those UV rays rather than trying to absorb it.” 

Patients with atopic dermatitis or other skin sensitivities often fare better with physical sunscreens, according to Browning, who noted that these formulations tend to be better tolerated. Additionally, physical blockers are typically considered reef-safe, making them a good option for families planning ocean activities like snorkeling. 

Still, Browning acknowledged that some chemical sunscreens—particularly those made with newer ingredients—can be suitable for many users, provided they don’t cause irritation. 

“There are also lots of great chemical sunscreens out there, and you can pick the ones that have the newer ingredients,” he said. “Don’t use it if it burns or stings. At the end of the day, the best sunscreen is the one that you're going to use,” Browning said. “So pick one out that you know you're going to use.” 

Pediatric dermatologist John Browning, MD, offers practical sun safety tips and guidance for selecting sunscreens, emphasizing the importance of choosing formulations that work for sensitive skin. 

Another month has come and gone, and with it, several FDA approvals and regulatory updates related to the ever-evolving landscape of pediatric health care.

In our May monthly recap, we list our top FDA-related news items so you can stay informed in an easy-to-read and quick format.

Take a look at our detailed coverage of FDA-related news from May, and easily stay in touch with 

 that bring you practical information for today's pediatrician.

Click the title of each story below for our full coverage of that regulatory update.

1. INF108 to prevent necrotizing enterocolitis receives FDA designations

On May 7, 2025, Infinant Health announced that INF108, its investigational drug for necrotizing enterocolitis (NEC) prevention in preterm infants, received orphan drug and rare pediatric disease designations from the FDA.

These designations aim to support the development of INF108 for NEC, a life-threatening intestinal condition that affects 7% of very low birth weight infants in NICUs. The company plans to initiate clinical trials to evaluate INF108 in preterm infants.

2. FDA clears EN-374 therapy application for X-linked chronic granulomatous disease

On May 12, 2025, the FDA cleared an investigational new drug (IND) application for Ensoma’s EN-374, a first-in-class in vivo gene therapy for X-linked chronic granulomatous disease (X-CGD).

EN-374 uses virus-like particles to deliver a CYBB transgene directly to hematopoietic stem cells, aiming to restore immune function in X-CGD patients. The therapy, which received orphan drug and rare pediatric disease designations, will enter a Phase 1/2 trial in late 2025.

FDA approves pediatric indication for Optison ultrasound enhancing agent

On May 13, 2025, the FDA approved GE HealthCare’s Optison (Perflutren Protein-Type A Microspheres) for pediatric use to enhance echocardiogram clarity.
Already approved for adults, Optison now helps improve visualization of left ventricular structures in children with suboptimal echocardiograms, aiding cardiac diagnosis.

4. FDA starts review of nutrients in infant formula

On May 13, 2025, the FDA and HHS issued a request for information to begin a comprehensive review of infant formula nutrients under "Operation Stork Speed."
This marks the first full review since 1988 and aims to update nutrient standards, enhance transparency, and improve formula safety and effectiveness for U.S. infants.

5. FDA seeks to remove ingestible fluoride products for children

On May 13, 2025, the FDA and HHS announced plans to remove pediatric ingestible fluoride prescription drugs from the market due to safety concerns.
Citing links to gut microbiome disruption and thyroid disorders, the FDA will review evidence and seek public comment by October 31, 2025, before taking action.

6. FDA accepts NDA for berotralstat in HAE patients aged 2 to 11 years

On May 14, 2025, the FDA accepted a new drug application for berotralstat (ORLADEYO) for the treatment of hereditary angioedema in children aged 2 to 11, with priority review.

If approved, berotralstat would become the first targeted oral prophylactic therapy for pediatric HAE patients, with a decision expected by September 12, 2025.

7. FDA approves NVX-CoV2705 COVID-19 vaccine

On May 19, 2025, the FDA approved Novavax’s NVX-CoV2705 (Nuvaxovid), the only protein-based, non-mRNA COVID-19 vaccine in the United States, for at-risk patients.
The vaccine is indicated for individuals aged 12 to 64 with underlying conditions and all adults 65 and older, based on phase 3 trial data showing strong safety and efficacy.

8. FDA approves Jivi for patients aged 7 years and older with hemophilia A

On May 19, 2025, the FDA approved Jivi (antihemophilic factor [recombinant], PEGylated-aucl; Bayer) for children aged 7 to <12 with hemophilia A.
This expanded indication is based on clinical trial data showing Jivi’s safety and efficacy in reducing bleeding episodes in pediatric patients with severe disease.

9. FDA approves roflumilast foam 0.3% for scalp, body psoriasis

On May 22, 2025, the FDA approved roflumilast (Zoryve) topical foam 0.3% to treat plaque psoriasis of the scalp and body in patients aged 12 years and older.
In phase 2 and 3 trials, the foam demonstrated significant improvements in psoriasis symptoms, including rapid itch relief, with strong safety and tolerability data.

10. FDA approves MenQuadfi meningococcal vaccine for children 6 weeks or older

On May 23, 2025, the FDA expanded the approval of MenQuadfi (Sanofi) to include infants aged 6 weeks to 23 months for the prevention of meningococcal disease.

MenQuadfi is now the only quadrivalent MenACWY vaccine approved for use from 6 weeks of age, with data showing comparable safety and immune response to existing vaccines.

A look back at the FDA submissions and regulatory decisions in the pediatric health care space from May 2025.

Ebony Williams, MD

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