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Richard A. Bermudes, MD, psychiatrist, chief medical officer, BrainsWay; associate physician, University of California Davis.

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.

Richard A. Bermudes, MD, underscored the need for pediatricians to integrate ongoing conversations into well visits in this video interview.

Richard Bermudes, MD, on screen-related addictions and youth mental health

The updated label is based on real-world data collected since B-VEC was launched in the United States, following its approval in May of 2023. 

FDA expands B-VEC label to include patients from birth with dystrophic epidermolysis bullosa

According to new, real-world data for trofinetide, caregivers reported quality-of-life, alertness, and interaction improvements at 12 months of treatment.

LOTUS study: Trofinetide data show Rett syndrome symptom improvement

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

Weekly review: New pediatric pneumococcal data, puzzler, and more

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

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Authors

Kari Allan, PharmD, BCPS, BCPPS, Children’s Hospital Colorado and the University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Aurora, Colorado.

**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.

Then visit our website on August 20 at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

This case was provided by Andrew Faniku, MD, pediatric hospitalist at Scott & White Healthcare.

A 21-year-old primigravida female presented to the hospital in preterm labor, with an otherwise uneventful pregnancy except for a febrile illness after exposure to family members with measles a week prior.

She reported having fever, cough, conjunctivitis, and a rash that started on her face and spread to her trunk, consistent with measles. Her fever and symptoms had mostly resolved, except for her lingering rash that began six days earlier. In the delivery room, she still had fresh excoriation marks on her arms. She had not received any MMR vaccines.

Six hours after admission, the patient delivered a female infant via spontaneous vaginal delivery at 35 weeks’ gestation. The baby weighed 2410 grams, which was approximately the 50

 percentile for her gestational age. The baby had mild respiratory distress after delivery and briefly required supplemental oxygen via blow by during transitioning. Apgar’s of 8 at 1 minute and 9 at 5 minutes was given at delivery. The baby subsequently improved and was allowed to room in with mother without the need for NICU admission. Nursing staff noticed a rash on the baby’s back. 

Below, take your best guess at diagnosing this patient

 website on Wednesday, August 20 at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

News

Case Studies

Can you diagnose this rash in a newborn?

A 32 weeks and 6/7 days, 1970 g infant was born via meconium-stained vaginal delivery to a 37-year-old G2P1 mother who recently immigrated from India. The mother presented with preterm premature rupture of membranes (PPROM) for 11 hours prior to eventual vaginal delivery. 

Maternal history was otherwise notable for rubella nonimmune, advanced maternal age, and a prior history of intrauterine fetal demise 4 years prior. Prior to delivery, the mother received 1 dose of ampicillin given unknown Group B streptococcus (GBS) status, and a single dose of betamethasone to accelerate fetal lung maturity.

After delivery, the infant was vigorous with delayed cord clamping of 1 minute. The Apgar scores were 8 and 8 at 1 and 5 minutes of life, respectively. There was mildly increased respiratory effort in the delivery room for which CPAP respiratory support was begun. The child was brought to the NICU on CPAP 5, 30% FiO2. 

E. coli with extended spectrum beta-lactamase

 website on Wednesday, September 10 at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis. 

A recently immigrated mother from India presents in preterm labor at 32 6/7 weeks and delivers a vigorous baby whose initial blood culture result is positive at 18 hours of life with gram-negative rods. 

Can you diagnose this infant with neonatal respiratory distress?

 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. 

 on Monday, March 24, 2025 at 12:00 PM ET or later for the full case presentation, differential diagnoses, and the correct patient diagnosis. 

This case was provided by Muhammad Aamir Anees and Bernard A. Cohen, MD

Want more puzzler and dermatology cases? 

A healthy 9-year-old girl developed an asymptomatic eruption of discrete and confluent, 2 to 3 mm, hypopigmented papules in a linear pattern along the lines of Blaschko on the back of her left thigh and leg over the past 3 weeks. The lesions cleared without treatment 4 to 5 months later. 

Inflammatory linear verrucous epidermal nevus

on Monday, March 24, 2025 at 12:00 PM ET or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

Take your best guess and try to diagnose this 9-year-old girl's linear eruption on the back of her left thigh and leg. Stay tuned for the full case presentation and correct diagnosis! 

Poll: What's the diagnosis of this linear eruption on the leg of a 9-year-old girl?

Florida is not aiming to ban vaccinations, but its surgeon general stated "Who am I to tell you what your child should put in [their] body? I don’t have that right."

Tina Tan, MD, reacts to state of Florida seeking elimination of all vaccine requirements

The state of Florida is seeking to end "all of" its vaccine mandates, according to  state Surgeon General Joseph Ladapo.

According to multiple national reports, the surgeon general on September 3 stated that forcing vaccine mandates is "wrong" and "immoral," according to a news article from NBC News. He is quoted as saying, "Who am I as a government or anyone else, who am I as a man standing here now, to tell you what you should put in your body? Who am I to tell you what your child should put in [their] body? I don’t have that right."

While the state is not banning vaccinations, Tina Tan, MD, FAAP, FIDSA, FPIDS, attending physician, Division of Infectious Diseases, Lurie Children’s Hospital of Chicago, and president, Infectious Diseases Society of America, said this news could cause misunderstandings for parents, who make vaccination decisions on behalf of their child.

"The problem is that now you are opening the door for vaccine-hesitant parents and antivaxxers to continue to increase. You are confusing people because they are thinking, 'They took the mandate away. I guess those things are not needed,'" Tan said. "This is really devastating news, because what is going to happen is you are going to see multiple outbreaks of vaccine-preventable diseases that are now going to spread very quickly, not only in Florida, but all over the US and then internationally."

is calling on the health care community to continue to explain the benefits of vaccines. 

"[Health care providers] need to remember to do what is best for their patients, and so they need to talk to the parents about why vaccines are important and why their kids should get them."


Diphtheria-tetanus-acellular pertussis (DTaP)

Currently, according to Florida's school immunization requirements, preschool entry requires the following vaccines

One tetanus-diphtheria-acellular pertussis (Tdap)

Two doses of Varicella. Varicella vaccine is not required if there is a history of varicella disease documented by the health care provider.

Regarding the anticipated changes coming to the vaccine requirements in Florida, Tan worries this could cause a ripple effect throughout the country. 

"This is basically just the first state, but this is opening the door for other states to do this," she said. "We need to protect everyone against getting a vaccine-preventable disease, because if a kid [gets] it in school, they can bring it home. There are people with immunocompromising conditions who cannot receive certain vaccines, so you need to protect them. The other problem is that if a growing number of individuals are not vaccinated, this is really going to cause these diseases to spread far and wide."

West A. Florida surgeon general says state will eliminate all vaccine mandates. NBC News. September 3, 2025. Accessed September 3, 2025. https://www.nbcnews.com/health/health-news/florida-surgeon-general-says-state-will-eliminate-vaccine-mandates-rcna228835

Fineout G. Florida moves to scrap state school vaccine requirements. Politico. September 3, 2025. Accessed September 3, 2025. https://www.politico.com/news/2025/09/03/florida-scrap-school-vaccine-requirements-00541739

School immunization requirements. Florida Health. Accessed September 3, 2025. https://www.floridahealth.gov/programs-and-services/immunization/children-and-adolescents/school-immunization-requirements/index.html

Florida is not aiming to ban vaccinations, but its surgeon general stated "Who am I to tell you what your child should put in [their] body? I don’t have that right." 

Watch our FDA pipeline news recap for the month for August 2025, as well as a preview of PDUFA dates listed for September. 

August's FDA Focus: Approvals and pipeline updates in pediatrics

Welcome to FDA Focus, where we take you back and recap some of the top FDA approvals of the month and provide a look ahead at what to expect in the month to come from the federal agency.

 FDA approved fremanezumab-vfrm (Ajovy; Teva Pharmaceuticals)

, to prevent episodic migraine in children aged 6 years and older, who weigh at least 99 lb. Previously indicated for adults, the drug is administered as a 225-mg monthly subcutaneous injection. Approval was based on data from the phase 3 SPACE trial, which demonstrated a significant reduction in monthly migraine days and a tolerability profile consistent with adult studies.

The next day, the agency approved tocilizumab-anoh for cytokine release syndrome in patients 2 years and older, bringing this biosimilar into full indication alignment with its reference drug Actemra. The IL-6 receptor antagonist is also approved for patients with polyarticular juvenile idiopathic arthritis and systemic juvenile idiopathic arthritis aged 2 years and older, as well as other adult indications. According to manufacturer Celltrion, tocolizumab-anoh was expected to be available in the US on August 31.

 to become the first treatment for noncystic fibrosis bronchiectasis in patients 12 years and older. The treatment was evaluated in the phase 3 ASPEN trial, which featured more than 1700 patients. Annualized pulmonary exacerbation rates were significantly reduced compared to placebo. Both the 10- and 25-mg doses of brensocatib improved exacerbation-related outcomes, with the latter also having slowed lung function decline.

The same day, the agency approved iron sucrose injection, USP as the first generic version of Venofer for the treatment of iron deficiency anemia in adults and children aged 2 years and older with chronic kidney disease. The intravenous product became the first generic version of Venofer injection.

As we look into September, we are keeping watch for the potential approval of berotralstat for HAE in patients aged 2 to 11 years. The FDA assigned a target action date of September 12, and previously granted priority review designation. If approved, berotralstat would become the first targeted oral prophylactic therapy for patients with hereditary angioedema under the age of 12 years.

Kari Allan, PharmD, BCPS, BCPPS

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