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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

 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.

The Committee is scheduled to meet on September 18 and 19 to discuss recommendations for several vaccines.

ACIP to meet for MMRV, Hep B, COVID vaccine proposed recommendations

According to the FDA, infant monitors sold without agency authorization pose safety risks and are not approved to prevent SIDS or SUID.

FDA alerts clinicians to potential harms from OTC infant monitoring devices

The agency "tentatively concluded that its use has been abandoned by industry and that the color additive regulation is outdated and unnecessary."

FDA could revoke authorization for Orange B color additive in food

Thao-Ly Phan, MD, MPH, Medical director of the Healthy Weight and Wellness Clinic, Nemours Children’s Health.

Thao-Ly Phan, MD, MPH, highlights how lessons from pandemic-related weight gain can guide pediatricians in addressing stress, prevention, and whole-child health.

Thao-Ly Phan, MD, MPH, stresses healthy routines to prevent weight gain during respiratory season

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

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A 19-year-old male presents to the emergency department (ED) with headache and fever of 4 days’ duration. Six days earlier, his left palm had been punctured by a rusty nail. What's the diagnosis?

Muscle spasms in a 19-year-old male

**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

On September 15, 2025, the FDA expanded the beremagene geperpavec-svdt (B-VEC; Vyjuvek; Krystal Biotech) indication to include patients from birth with dystrophic epidermolysis bullosa (DEB), expanding on the previous indication of 6 months or older.

Originally approved by the FDA in May 2023, B-VEC can now provide full flexibility with respect to application and management of wound dressings, according to a press release from Krystal Biotech. In addition to allowing patients with DEB and caregivers to apply B-VEC at home and on their own, the label update allows wound dressings to be removed as part of the next dressing change rather than waiting 24 hours. 

"This just represents an immense move forward in terms of actual rational design of a treatment where we can actually make a big difference in individuals' lives," said Raj Chovatiya, MD, PhD, in a

 at the time of the original B-VEC approval.

“We believe these changes further reinforce [B-VEC's] leadership position as the most flexible, convenient, and disease-modifying medicine to treat DEB patients in the United States,” said Krish S. Krishnan, chairman and CEO of Krystal Biotech, of the updated label. "Overall, we believe that these advancements solidify [B-VEC] as the standard of care for all DEB wounds, regardless of wound size and severity, and will further improve compliance.”

Approval of the updated label was based on real-world data collected since the topical's launch in the United States in addition to results from the open-label extension study (NCT04917874) conducted in the US earlier in 2025. Results reinforced efficacy and safety of B-VEC across ages, including in cases of patient or caregiver application.

A total of 47 patients, including 24 rollover participants from the phase 3 trial and 23 treatment-naive individuals, received weekly applications of B-VEC to target wound areas for up to 112 weeks (median, 81 weeks). Safety assessments focused on adverse events, whereas exploratory outcomes included treatment satisfaction, quality of life, and wound closure rates among rollover participants.

Overall, 74.5% of patients experienced at least 1 adverse event, the majority of which were mild or moderate in severity. Seventeen serious adverse events were reported in 14 patients, and 14 severe adverse events were noted in 10 patients; however, none were deemed treatment related. No adverse events led to study discontinuation. Patient-reported outcomes suggested consistently high levels of treatment satisfaction, though quality-of-life measures yielded inconclusive results.

How FDA-approved B-VEC will help children with dystrophic epidermolysis bullosa, with Bernard A. Cohen, MD

Wounds that had been treated with B-VEC during the phase 3 study maintained high rates of closure throughout the extension, ranging from 61.1% to 89.5% between baseline and month 12. These findings reinforce the long-term safety profile of B-VEC and its ability to sustain clinical benefit over extended treatment periods. Although the open-label design and variable follow-up remain limitations, the data support the continuous use of B-VEC for DEB management. 

"The updates to the [B-VEC] label are yet another significant and impactful step forward for all those living with DEB,” added Brett Kopelan, executive director of debra of America, in a statement. "Enabling caretakers to apply [B-VEC] during their standard-of-care regimen is an enormous positive change, allowing for increased convenience without sacrificing safety. This aspect of the update to the label will only increase the quality of life of those living with this challenging disorder, and that is exactly what our community needs.”

Krystal Biotech announces FDA approval of updated Vyjuvek label. Press release. Krystal Biotech Inc. September 15, 2025. Accessed September 15, 2025. https://ir.krystalbio.com/news-releases/news-release-details/krystal-biotech-announces-fda-approval-updated-vyjuvekr-label

Fitch J. FDA approves B-VEC to treat dystrophic epidermolysis bullosa patients 6 months and older. 

. May 19, 2025. Accessed September 15, 2025. https://www.contemporarypediatrics.com/view/fda-approves-b-vec-to-treat-dystrophic-epidermolysis-bullosa-patients-6-months-and-older

Marinkovich MP, Paller AS, Guide SV, et al. Long-term safety and tolerability of beremagene geperpavec-svdt (B-VEC) in an open-label extension study of patients with dystrophic epidermolysis bullosa. 

. 2025;26(4):623-635. doi:10.1007/s40257-025-00942-y

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

News

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

 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.

Case Studies

Can you diagnose this rash in a newborn?

Bite injuries are a significant problem in the United States. Discriminating between human and animal bites and identifying those associated with child maltreatment is essential. Approximately 250,000 human bites and several million animal bites occur annually.

 There was also a reported increase in animal bite injuries during the COVID-19 pandemic.

 Despite their frequency, it can be challenging to distinguish between types of bites. There are also few detailed images and descriptions of cutaneous findings of human and animal bites in the literature. 

Additionally, though such injuries occur in various ways, pediatric providers must consider the possibility of child maltreatment. In the COVID-19 pandemic, there was also a documented increase in child abuse–related injuries.

 Though bite wounds are a less common cutaneous finding in child abuse,

 both human and animal bites may result from nonaccidental trauma or neglect. 

In the poll below, try to identify what caused this bite mark on the palm of a 16-year-old boy

Thank you for taking this Contemporary Pediatrics puzzler poll

Visit ContemporaryPediatrics.com on Wednesday, August 6, 2025, at 12:00 PM ET or later for many more bite examples in the pediatric population and how to distinguish between common animal bites and human bites.

"This [case] was prompted by the increases in child abuse and animal bite injuries during the COVID-19 pandemic, with the need to add to the limited descriptions of cutaneous findings of bites in the literature," wrote the authors of this case.

Bula-Rudas FJ, Olcott JL. Human and animal bites. 

. 2018;39(10):490-500. doi:10.1542/pir.2017-0212

Dixon CA, Mistry RD. Dog bites in children surge during coronavirus disease-2019: a case for enhanced prevention. 

. 2020;225:231-232. doi:10.1016/j.jpeds.2020.06.071

Kovler ML, Ziegfeld S, Ryan LM, et al. Increased proportion of physical child abuse injuries at a level I pediatric trauma center during the Covid-19 pandemic. 

. 2021;116(Pt 2):104756. doi:10.1016/j.chiabu.2020.104756

Kos L, Shwayder T. Cutaneous manifestations of child abuse. 

. 2006;23(4):311-320. doi:10.1111/j.1525-1470.2006.00266.x

Despite their frequency, it can be challenging to distinguish between types of bites. Can you identify the source of this bite mark? 

Puzzler poll: Can you identify this bite? 

Trofinetide (Daybue; Acadia Pharmaceuticals) treatment among 277 people living with Rett syndrome led to caregiver-reported improvements in symptoms, from behavioral symptoms to improvements in nonverbal communication, alertness, and social interactions, according to interim data newly published in the 

Developmental Medicine & Child Neurology 

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

William Kenan

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