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Meet the Editors

 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.

Articles

FDA approves updated COVID-19 vaccines for 2025–2026 but limits pediatric access, restricting use to older and high-risk groups.

FDA pulls clearance of Pfizer, BioNTech COVID-19 vaccine for children under 5

A recent study found child depression predicted later maternal depression, highlighting the need for family-centered care.

Child depression during early adolescence drives later maternal depression 

Donna Hallas, PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN, shares her thoughts on the role PNPs play in vaccine education for parents and caregivers.

PNP Perspective: Evidence-based vaccine decision making

Muhammad Aamir Anees is a medical student at Kanachur Institute of Medical Sciences in Mangalore, India.

Patches of hair loss on scalp

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Treatments for cystic fibrosis are evolving. Here’s a look at new CFTR modulator therapies including the most recent approval-elexacaftor/tezacaftor/ivacaftor (Trikafta).

Triple combination therapy for cystic fibrosis is here!

**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

The first results from a multiyear immunoepidemiologic study, published in 

, provide new insights into the dynamics of endemic virus re-emergence in children in the United States following the COVID-19 pandemic. The study, part of the Pandemic Response Repository through Microbial and Immune Surveillance and Epidemiology (PREMISE) program, highlights how disruptions in viral exposure during the pandemic shaped subsequent outbreaks of respiratory pathogens in pediatric populations.

PREMISE, led by the National Institutes of Health (NIH) Vaccine Research Center, was established to translate immune surveillance data into improved outbreak prediction and development of countermeasures. As proof of principle, investigators conducted a prospective, multicenter, longitudinal study from January 2022 through June 2023 at Children’s Hospital Colorado/University of Colorado Anschutz Medical Campus, University of North Carolina, Weill Cornell Medicine, and the University of Alabama at Birmingham.

Eligible participants included children aged 10 years or younger. Blood specimens were obtained pre- and post–enterovirus season, while respiratory swabs were collected during symptomatic illness. Serological analyses measured antibody binding to a panel of 16 endemic respiratory viruses, including enterovirus D68 (EV-D68), respiratory syncytial virus (RSV), influenza, and SARS-CoV-2.

Of 488 eligible children, 174 were enrolled with a median age of 3.4 years. Ninety paired serum samples and 73 respiratory swabs were analyzed. Results demonstrated substantial increases in antibody binding and neutralizing titers across all viral pathogens studied, particularly in younger children with low baseline immunity. The highest exposure rates were documented for SARS-CoV-2 (59%), EV-D68 (41%), RSV (41%), and influenza (40%).

Respiratory sequencing identified EV-D68, rhinovirus A, and rhinovirus C as the most frequently detected pathogens. All EV-D68 isolates belonged to clade B3. Importantly, incorporating serological data into predictive models reduced the range of prediction errors for EV-D68 transmission dynamics by 82% compared with models based solely on national case surveillance data.

The study captured immunologic evidence that nonpharmaceutical interventions (NPIs) during COVID-19, such as masking and distancing, resulted in markedly reduced circulation of endemic viruses. This led to an accumulation of susceptible children who later experienced a surge of infections when NPIs were lifted. “The data showed that most younger children lacked immunity to many normal respiratory viruses during the pandemic, suggesting they had not been exposed, as they typically would have, due to prevention measures in place,” the authors reported.

Following the relaxation of NPIs, immunity rose rapidly across pathogens, reflecting the widespread resurgence observed nationally. Lead investigator Kevin Messacar, MD, PhD, professor of pediatrics at the University of Colorado School of Medicine and infectious disease specialist at Children’s Hospital Colorado, noted, “In the future, this type of immune surveillance can be used to better understand the impact of public interventions on population immunity and future waves of disease. PREMISE is a great example of a successful research partnership between NIH scientists and clinical researchers in academia, leading to concrete deliverables such as vaccine candidates and monoclonal antibodies that can directly impact public health.”

The PREMISE program extends beyond monitoring single diseases by building a biorepository of immune data and viral specimens. As lead author Hai Nguyen-Tran, MD, of Children’s Hospital Colorado, explained, “Four cohorts of almost 1000 children have provided an invaluable bank of samples and data. These are being used to develop ‘on the shelf’ medical countermeasures, such as antibody treatments and vaccines, for pathogens of interest. Instead of starting from scratch, this study gives us a head start to understand, predict, and prepare for future pandemics.”

Samples are also being used to identify viral epitopes targeted by natural immunity, aiding in the design of next-generation antibody therapies and vaccines. The study’s predictive models demonstrated the feasibility of combining serological surveillance with epidemiologic modeling to improve forecasts of outbreak timing and intensity.

This initial report from PREMISE establishes proof of concept for immunoepidemiologic surveillance as a tool for outbreak preparedness. By combining immune data with traditional surveillance, the program enhances the precision of predictive models and supports the development of countermeasures. As new pediatric immunizations, including RSV prevention strategies, are introduced, such approaches may help monitor changes in immunity and circulation dynamics across populations.

Novel immunologic surveillance study provides new insights into post-pandemic return of respiratory viruses. News release. Children's Hospital Colorado. August 7, 2025. Accessed August 18, 2025. https://www.eurekalert.org/news-releases/1093905

Nguyen-Tran H, Park SW, Vogt MR, et al. Dynamics of endemic virus re-emergence in children in the USA following the COVID-19 pandemic (2022-23): a prospective, multicentre, longitudinal, immunoepidemiological surveillance study. 

. Published online August 6, 2025. doi:10.1016/S1473-3099(25)00349-4

Immune surveillance study shows pandemic interventions suppressed viral exposure in children, driving post-COVID resurgence and future outbreak risk.

News

Immune surveillance study reveals drivers of postpandemic viral resurgence in children

A diet high in omega-3 polyunsaturated fatty acids (PUFAs), primarily obtained from fish oils, may lower the risk of myopia in children, according to findings published in the 

. In contrast, a diet rich in saturated fats, such as those found in butter, palm oil, and red meat, may increase the risk of the condition.

The global prevalence of myopia continues to rise, with projections suggesting that nearly half of the world’s population will be affected by 2050. Risk factors for myopia are understood to include excessive near work, limited time outdoors, and genetic predisposition. Diet, however, has been less well established as a modifiable factor influencing refractive development.

Researchers from the Hong Kong Children Eye Study analyzed dietary patterns and ocular health outcomes in 1005 Chinese children aged 6 to 8 years. The cross-sectional study used a validated food frequency questionnaire covering 280 food items across 10 food categories. Axial length (AL) and cycloplegic spherical equivalent (SE) refraction were measured to assess eye growth and refractive status.

Among the participants, 276 children (27.5%) were found to have myopia. Analysis demonstrated that axial length was significantly longer in children in the lowest quartile of omega-3 fatty acid intake compared with those in the highest quartile (adjusted mean, 23.29 mm vs 23.08 mm; 

 = .01). SE also showed a protective association, with the lowest quartile group averaging more myopic refractions (−0.13 D) compared with the highest quartile (+0.23 D; 

 = .01). Conversely, children in the highest quartile of saturated fat intake demonstrated longer AL and more myopic SE compared with those in the lowest quartile.

“This study provides the human evidence that higher dietary ω-3 PUFA intake is associated with shorter axial length and less myopic refraction, highlighting ω-3 PUFAs as a potential protective dietary factor against myopia development,” the investigators concluded.

The biological mechanisms underlying these associations may relate to ocular blood flow. Omega-3 fatty acids are believed to increase choroidal blood circulation, supplying oxygen and nutrients to the sclera and thereby reducing scleral hypoxia, a known factor in myopia development. In contrast, saturated fats are associated with insulin resistance, which has been hypothesized to play a role in excessive axial elongation.

The study builds on prior animal research that has suggested a protective role for omega-3 fatty acids in slowing myopia progression. For example, supplementation in animal models has been shown to suppress experimentally induced myopia and reduce scleral hypoxia. However, this is the first large-scale study in humans to establish a significant association between dietary omega-3 intake and myopia.

While the findings highlight a potential dietary strategy for mitigating myopia risk, the authors acknowledged important limitations. As an observational cross-sectional study, the data cannot establish causality. The use of food frequency questionnaires introduces the possibility of recall bias, and dietary intakes were not validated with serum biomarkers. Additionally, the study population was limited to Chinese children in Hong Kong, a population with one of the world’s highest myopia prevalence rates, which may limit generalizability to other ethnic groups and geographic regions.

Despite these limitations, the results suggest that dietary interventions may play a role in public health strategies for addressing myopia. “Our findings indicated a possible effect of diet on myopia, of which ω-3 PUFAs intake may play a protective role against myopia development in children,” the authors noted.

Further longitudinal studies and randomized clinical trials are warranted to confirm these findings and determine whether omega-3 supplementation or dietary modification can effectively reduce the onset or progression of myopia in pediatric populations.

Diet rich in omega-3 fatty acids may help ward off short sightedness in children. News release. BMJ Group. August 19, 2025. Accessed August 20, 2025. https://www.eurekalert.org/news-releases/1095033

Zhang XJ, Zhang Y, Zhang YJ, et al. Dietary omega-3 polyunsaturated fatty acids as a protective factor of myopia: the Hong Kong Children Eye Study. 

Published online August 19, 2025. doi:10.1136/bjo-2024-326872

Higher omega-3 intake may protect children from myopia, while diets high in saturated fats may raise risk, study finds.

Omega-3 fatty acid intake linked to reduced risk of myopia in children

A 23-month-old female presented with a 3-day history of cough, rhinorrhea, and increased work of breathing. Initially, she was treated for bronchiolitis at an urgent care center, where a nasopharyngeal swab identified adenovirus. Despite initial treatment, the patient's condition worsened, and she required oxygen supplementation via nasal cannula for oxyhemoglobin desaturation. Her hypoxemia further deteriorated, necessitating an increase in oxygen supplementation (

On physical examination, the patient showed signs of respiratory distress. A chest x-ray (CXR) revealed opacities in the right middle and lower lobes. The patient's condition improved with supportive care, and she was discharged after several days in the hospital. 

However, 9 months later, due to recurrent wheezing, she was referred to the pulmonary service for further evaluation. A follow-up CXR, taken 3 months after the initial infection, demonstrated complete opacification of the right hemithorax with a mediastinal shift to the right as well as collapse of the right upper and middle lobes. 

On physical examination, the patient appeared in mild respiratory distress. Her oxygen saturation was 96% on room air. Breath sounds were diminished on the left side, with crackles noted in the right lower lung fields. Her growth and development were normal, and she was in the 25th percentile for both height and weight. A complete blood count and metabolic panel were within normal limits. 

Due to recurrent wheezing, she was referred to the pulmonary service. A follow-up CXR (3 months afterward) showed complete opacification of the right hemithorax with mediastinal shift to the right and collapse of the right upper and middle lobes (

). CT scan of the chest revealed unilateral hyperlucency of the left lung. There was complete opacification of the right hemithorax, mediastinal shift to the right, and atelectasis of the right upper and middle lobes with superimposed bronchiectasis (

). Her findings were consistent with Swyer-James-MacLeod Syndrome (SJMS) (

). Her condition was managed with inhaled corticosteroids, chest physiotherapy, and antibiotics during exacerbations. Her most recent CXR, 15 months after initial presentation, continues to reveal hyperlucency of the left lung (

Her condition was managed with inhaled corticosteroids, chest physiotherapy, and antibiotics during exacerbations. 

We present a rare case of SJMS in a pediatric patient. SJMS is a postinfectious bronchiolitis first described by Swyer and James in 1953.

 This condition is characterized by unilateral hyperlucency of the lung, typically following a viral or bacterial infection in infancy or early childhood. Our patient’s diagnosis followed recurrent respiratory infections and lung collapse. 

SJMS can be associated with numerous infections, including adenovirus types 3, 7, and 21, paramyxovirus, 

 These infections lead to inflammation and fibrosis that cause bronchial lumen narrowing, reduced ventilation/perfusion, and vasoconstriction, consequently reducing blood flow to the pulmonary artery and leading to arterial hypoplasia.

 In addition, decreased pulmonary vascularization, abnormal alveolar development, and destruction of the pulmonary parenchyma and alveoli are observed.

Due to its rarity, little is known about the incidence of SJMS, and the clinical course varies based on the presence or absence of bronchiectasis.

 Adults with SJMS are often asymptomatic, with the condition being an incidental finding on imaging. In contrast, children tend to be symptomatic, presenting in infancy or early childhood with dyspnea, wheezing, recurrent respiratory infections, productive cough, failure to thrive, and, rarely, hemoptysis and spontaneous pneumothorax.

Diagnostic tools such as bronchoalveolar lavage have shown active inflammatory processes in SJMS, with increased neutrophils and lymphocytes, specifically CD8+ T cells.

 Pulmonary function tests may reveal mixed obstructive-restrictive ventilation defects.

 Imaging remains key to diagnosis, with chest x-ray and CT scans revealing characteristic findings of unilateral hyperlucency, bronchiectasis, and lung collapse, as seen in our patient.

In the differential diagnosis of unilateral hyperlucency (Table), conditions such as congenital lobar emphysema (CLE), congenital pulmonary airway malformation, and pulmonary sequestration must be considered. CLE presents with respiratory distress in infancy and hyperinflation of the lung lobe, whereas SJMS typically follows an infectious process and affects an entire lung. Pulmonary sequestration, involving nonfunctioning lung tissue with an aberrant blood supply, also needs to be ruled out using imaging studies such as CT or MRI. 

Kimberly M. Dickinson, MD, MPH

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