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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

Pediatric cancer survivors can be vulnerable to cardiovascular disease in the short- or long-term with increased recognition of cardiotoxic cancer treatments, as 5-year survival rates for children are greater than 85%. 

Pediatric cancer survivors and cardiovascular toxicity, disease risk

With 1 in 7 adolescents worldwide diagnosed with mental health disorders, emerging research suggests that diet is a powerful yet often overlooked therapeutic tool. 

Brain food: Nutrition's critical role in teen mental health

Walker and Harris emphasize the importance of early hearing loss detection, screening, and intervention to support optimal child development.

Camille Walker, Sacheen Harris discuss hearing loss, screenings, and testing in primary care

The PANDAS/PANS questionnaire is based on symptoms and comorbidities described in the literature and is a self-report completed by parents of children younger than 18.

New questionnaire effectively screens for PANDAS/PANS

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A short window of action exists for the newborn with suspected sepsis. With little time and less-than-perfect lab studies, are CRP values the added clue you need to arrive at a diagnosis?

Is CRP in neonatal sepsis a helpful marker?

**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

Invasive meningococcal disease (IMD) is a life-threatening infection caused by 

. Although IMD is relatively rare in the United States, it progresses rapidly and can lead to death or long-term complications among survivors, particularly in infants and adolescents. 

Recently, the CDC has reported an increase in the incidence of IMD, which has one of the highest case fatality rates among vaccine-preventable diseases, with a death rate of 10% to 15% even with appropriate treatment, sometimes occurring within 24 hours.

 Up to 20% of survivors suffer long-term consequences, such as brain damage, limb loss, hearing loss, and neurological problems.

Adolescents are at high risk because of behaviors common in this age group, such as living in close quarters and sharing drinks. 

Vaccines against the 5 major serogroups have been available and recommended for adolescents for the past decade. These include MenACWY vaccines such as Menveo (GSK), MenQuadfi (Sanofi Pasteur), which protect against serogroups A, C, W, and Y, and MenB vaccines such as Bexsero (GSK), Trumenba (Pfizer), which protect against serogroup B. 

Penbraya (Pfizer) is also available as a combination MenABCWY vaccine, 

 for the prevention of 5 major serogroups that cause the majority of invasive meningococcal disease in patients ages 10 to 25 years.

Further, Penbraya was recommended by the CDC's Advisory Committee on Immunization Practice (ACIP) for the prevention of these most common meningococcal serogroups in adolescents and young adults ages 16 to 23 years.

the Penmenvy vaccine was approved by the FDA. However, vaccination rates remain low, with persistent racial and geographic disparities.

Currently, meningococcal vaccination in the United States typically requires 2 separate quadrivalent (A, C, W, Y) meningococcal conjugate vaccines and 2 serogroup B meningococcal vaccines. These vaccines are licensed and recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP). Only 13% of 17-year-olds have completed the vaccination series against serogroup B, the most common disease-causing serogroup at this age.

Serogroup B is the leading cause of IMD in older adolescents and young adults (aged 16 to 23 years), responsible for 53% of cases in this age group compared to 29% caused by serogroups C, W, and Y combined. As of 2023, only 32% of 17-year-olds have received at least 1 dose of the MenB vaccine, and only 13% have received both doses required for optimal protection. Continued efforts are needed to ensure vaccine access and information, focusing on populations at greatest risk, primarily older adolescents.

GSK's pentavalent vaccine could provide comprehensive protection by covering the 5 most common serogroups in a single shot. The GSK's MenABCWY (5-in-1) vaccine is designed to replace separate meningococcal vaccines by combining protection against 

Since 2005, ACIP has recommended routine vaccination against serogroups A, C, W, and Y at ages 11 to 12 years, with a booster at age 16 years. It is also recommended for college students in dormitories, military recruits, individuals with certain medical conditions, and travelers to high-risk regions.

Reacting to the meningococcal ABCWY vaccine approval with Donna Hallas, PhD, PPCNP-BC

Currently, it is recommended that adolescents who need both a MenACWY and MenB vaccine at the same visit, typically at age 16. Adolescents must receive a MenB vaccine dose from the same manufacturer at least 6 months after the MenABCWY dose for optimal protection. 

Penmenvy is indicated as a 2-dose series for individuals aged 10 to 25 years. At the time of this publication, ACIP is considering reassessing the meningococcal vaccination schedule during its 2025 meetings, and updated recommendations could increase the role of GSK's MenABCWY in adolescent immunization while maintaining options for monovalent and quadrivalent vaccines.

Clinical trials have shown Penmenvy to have a safety profile comparable to existing meningococcal vaccines, with no new serious safety concerns. Its reactogenicity is similar to that of MenACWY and MenB vaccines, with side effects such as injection site reactions, fatigue, headache, muscle or joint pain, fever, chills, and nausea.

In summary, the recent FDA approval of Penmenvy offers comprehensive protection, simplifies the immunization schedule, improves vaccine compliance, enhances immune response, reduces health care visits, and protects high-risk groups. The safety profile of Penmenvy appears to be comparable to that of the currently available meningococcal vaccines.
 


1. CDC. Meningococcal disease: diagnosis, treatment, and complications. 2020. 

https://www.cdc.gov/meningococcal/about/diagnosis-treatment.html

2. Olbrich, K.J., Müller, D., Schumacher, S. 

 Systematic Review of Invasive Meningococcal Disease: Sequelae and Quality of Life Impact on Patients and Their Caregivers. 

https://doi.org/10.1007/s40121-018-0213-2



3. CDC. Meningococcal Disease Symptoms and Complications. CDC. August 30, 2024.

4. FDA Approves PENBRAYA, the First and Only Vaccine for the Prevention of the Five Most Common Serogroups Causing Meningococcal Disease in Adolescents. Pfizer. Press release. October 20, 2023. https://www.pfizer.com/news/press-release/press-release-detail/fda-approves-penbrayatm-first-and-only-vaccine-prevention

5. Pfizer’s PENBRAYA™ Receives Recommendation for Prevention of Meningococcal Disease in Adolescents and Young Adults from Advisory Committee on Immunization Practices. Pfizer. Press release. October 25, 2023. https://www.pfizer.com/news/announcements/pfizers-penbrayatm-receives-recommendation-prevention-meningococcal-disease

6. Collins JP, et al. Use of the Pfizer Pentavalent Meningococcal Vaccine Among Persons aged >
10 Years: Recommendations of the Advisory Committee on Immunization Practices—United States, 2023. MMWR Morb Mortal Wkly Rep 2024; 73:345-350.
DOI: http://dx.doi.org/10.15585/mmwr.mm7315a4

C. et at. National Vaccination Coverage Among Adolescents Aged 13–17 Years. National Immunization Survey-Teen, United States, 2023. CDC, MMWR, 

8. Mbaeyi, S.A., et al. Meningococcal Vaccination: Recommendations of the Advisory Committee on Immunization Practices, United States, 2020. CDC, MMWR. Weekly, September 25, 2020, 69 (9); 1-41.

9. Clements, DE, et al. (2024). Past, present, and future policy considerations regarding meningococcal vaccination in the United States. Expert Review of Vaccines, 23, 845-861.


https://doi.org/10.1080/14760584.2024.2397705

10. GSK’s 5-in-1 meningococcal ABCWY vaccine candidate accepted for regulatory review by US FDA. GSK. News release. Published April 16, 2024. Accessed February 13, 2025. https://www.gsk.com/en-gb/media/press-releases/gsk-s-5-in-1-meningococcal-abcwy-vaccine-candidate-accepted-for-regulatory-review-by-us-fda/

11. Beran J, et al. Immunogenicity and Safety of Investigational MenABCWY Vaccine and of 4CMenB and MenACWY Vaccines Administered Concomitantly or Alone: a Phase 2 Randomized Study of Adolescents and Young Adults. mSphere. 2021 Dec 22;6(6): e0055321. doi: 10.1128/mSphere.00553-21.

Amin Barakat, MD, FAAP, details meningococcal disease vaccines and highlights the recently FDA-approved MenABCWY vaccine from GSK.

News

Breaking down invasive meningococcal disease vaccines, including Penmenvy

 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! 

Case Studies

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

At the 2025 NAPNAP Conference in Chicago, Jessica Spruit, DNP, CPNP-AC, FAANP, discussed the AAP's first clinical practice guideline on opioid prescribing. 

Discussion: AAP's opioid for acute pain clinical practice guideline with Jessica Spruit, DNP

At the 2025 NAPNAP National Conference on Pediatric Health Care in Chicago, Illinois, Jessica Spruit, DNP, CPNP-AC, FAANP, discussed the American Academy of Pediatrics' (AAP) first clinical practice guideline (CPG) on "Opioid Prescribing for Acute Pain Management in Children and Adolescents in Outpatient Settings." The guideline seeks to balance effective pain management with opioid safety and addresses disparities in pediatric pain treatment.

“This is actually a brand new guideline. It's the first of its kind. The AAP really took this on with the intention of promoting appropriate prescribing of opioids,” Spruit stated.

“We know that in the setting of an opioid crisis, certainly there's reason for all of us as clinicians to be cautious and thoughtful about the way we utilize and prescribe opioids in our practice," Spruit added. "But what we also worry about is that some pain is inadequately managed as a consequence of regulations and kind of pulling back on the utilization of those medications which do have a long track record of beneficial use. So it’s all about the thoughtful and appropriate prescribing, and this guideline provides some guidance to promote that.”

The guideline emphasizes a multimodal approach to pain management, urging clinicians to combine non-opioid medications and non-pharmacologic therapies when treating acute pain. According to the CPG, opioid monotherapy should not be used for children and adolescents. Instead, opioids should only be used in combination with other pain management strategies.

Spruit highlighted another significant recommendation:

“The other thing that really stood out to me, which had a really high grade in the quality of evidence, was regarding the disposal of opioids following utilization of that prescription. Excess opioids should be disposed of, and if we provide that education with the mode of disposing it, [such as] talking about DEA take back events, using those mail return envelopes, that's all really helpful in promoting adherence to those recommendations for the families we serve.”

A major concern addressed in the guideline is the risk of opioid misuse among adolescents.

Matthew A. Saxonhouse, MD

Articles

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