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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.

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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.

IDWeek 2025 heads to Atlanta October 19–22 with cutting-edge sessions on AMR, AI, vaccines, HIV, pediatrics, and global health challenges.

IDWeek 2025 to spotlight innovation, AI, and global collaboration in infectious diseases

IDSA’s new GAS pharyngitis guidance emphasizes selective testing using clinical scoring to reduce overtreatment and antibiotic misuse.

IDSA recommends use of scoring systems to guide testing for group A streptococcal pharyngitis

Craig Press, MD, PhD, Associate professor, Clinical Neurology, University of Pennsylvania; Medical director, Neuroscience Unit, Children's Hospital of Philadelphia.

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

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

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

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

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Laura Santry, MD, is a third-year PEM fellow at Nemours Children's Hospital in Delaware.

**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?

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.

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

 to monitor real-time treatment response 

“One of the most important things we deal with in pediatrics is that therapies developed in adults often haven’t been tested in children yet. We’re trying to pull together large samples of kids to better understand responses to therapy, so we’re not just relying on correlations or individual cases to drive care,” he said.

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

2025 American Academy of Otolaryngology–Head and Neck Surgery meeting

 showed that 11 of 12 children treated with Regeneron’s investigational 

 gene therapy experienced clinically meaningful hearing improvements, with 3 having achieved normal hearing levels (HLs).

The findings come from the pivotal phase 1/2 CHORD trial (NCT05788536), which is evaluating DB-OTO for profound genetic hearing loss caused by variants in the 

 gene. The therapy uses a dual adeno-associated virus vector to deliver a functional copy of the 

 gene to inner ear hair cells, aiming to restore natural acoustic hearing.

Among 12 treated participants aged 10 months to 16 years, 9 received DB-OTO in one ear and 3 in both ears.

 Nearly all participants (11 of 12; 14 of 15 treated ears) demonstrated improved hearing within weeks of treatment. By week 24, 9 children achieved hearing thresholds of ≤ 70-dB HL on behavioral pure-tone audiometry, meeting the primary efficacy end point.

 This level of hearing typically does not require cochlear implantation and enables natural acoustic hearing.

Six participants could hear soft speech without assistive devices, and 3 achieved normal hearing sensitivity. 

One child who did not initially meet the primary end point showed continued improvement and reached near-normal HLs at week 48. 

In addition, 9 participants demonstrated an auditory brainstem response at ≤ 90-dB normalized HL, achieving the trial’s key secondary end point.

Among 8 participants followed for 36 weeks or longer, hearing gains remained stable or continued to improve. In 3 children who underwent speech assessments at week 48, all showed significant gains, including improved word recognition and the ability to detect distant or low-volume sounds.

DB-OTO and its surgical administration were well tolerated. No therapy-related serious adverse events were reported. Two participants experienced serious events unrelated to DB-OTO, with one linked to a cochlear implant surgical complication and another to a recent vaccination. Transient vestibular symptoms such as dizziness or nausea were reported in some participants and resolved fully.

The therapy has received orphan drug, rare pediatric disease, fast track, and regenerative medicine advanced therapy designations.

Context and previous data on DB-OTO gene therapy

Jay T. Rubinstein, MD, PhD, highlighted promising CHORD trial data showing that DB-OTO gene therapy has led to hearing improvements in treated participants. 

Regeneron’s DB-OTO shows sustained hearing recovery in phase 1/2 CHORD trial

Earlier data from the CHORD trial, discussed in a March 7, 2025, interview with 

, Virginia Merrill Bloedel Professor of Otolaryngology and Bioengineering at the University of Washington, highlighted similar outcomes. At that time, 10 of 11 participants with at least 1 posttreatment assessment showed measurable hearing improvement, including several who reached near-normal or normal hearing thresholds.

Rubinstein described the initial results as “a home run,” noting that the first treated child exhibited “a remarkable degree of hearing restoration” when observed without a cochlear implant. He emphasized that additional follow-up will further clarify speech perception outcomes as children continue to progress.

According to Regeneron, a regulatory application for the gene therapy is planned for "later this year," pending discussion with the FDA.

DB-OTO results in the New England Journal of Medicine showcase dramatic and sustained improvements in hearing and speech perception in children with profound genetic hearing loss. Press release. Regeneron. October 12, 2025. Accessed October 13, 2025. https://investor.regeneron.com/news-releases/news-release-details/db-oto-results-new-england-journal-medicine-showcase-dramatic

Valayannopoulos V, Bance M, Carvalho DS, et al. DB-OTO gene therapy for inherited deafness. 

. Published online October 12, 2025. doi:10.1056/NEJMoa2400521

Fitch J. Jay Rubinstein, MD, PhD, explains DB-OTO gene therapy in children with profound hearing loss. 

. March 7, 2025. Accessed October 13, 2025. https://www.contemporarypediatrics.com/view/jay-rubinstein-md-explains-db-oto-gene-therapy-in-children-with-profound-hearing-loss

In a recent trial, 11 of 12 children treated with DB-OTO demonstrated meaningful hearing gains.

Then visit our website on September 24, 2025, at 3:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

Try to diagnose this patient with 3 days of right-sided neck swelling. 

Laura Santry, MD

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