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Meet the Editors

. 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

Once-daily icotrokinra versus placebo demonstrated clinically significant skin clearance in those with moderate-to-severe plaque psoriasis. 

New phase 3 data of JNJ-2113 for plaque psoriasis in patients aged 12 years, older

A further understanding of the role SARS-CoV-2 plays in T2D incidence can add an important component to benefit and risk considerations to prevent COVID-19. 

COVID-19 among adolescents, teens and type 2 diabetes incidence

Stephanie Anne Deutsch, MD, MS, MSCR, FAAP, joined us to discuss a new study that highlighted SUID among infants who were prenatally substance exposed. 

Prenatally substance-exposed infants and SUID outcomes

H. Westley Phillips, MD, explains why awareness and availability of epilepsy surgery is important for pediatric providers among drug-resistant epilepsy patients. 

Awareness for epilepsy surgery among drug-resistant pediatric patients

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Authors

Leah K. Middelberg, MD, FAAP, is an assistant professor of pediatrics in the Division of Emergency Medicine at Nationwide Children’s Hospital, Columbus, Ohio.

A 5-year-old boy with a history of asthma presented for a 1-year history of multiple episodes of emesis. What's the diagnosis?

Multiple episodes of repetitive vomiting in a 5-year-old boy

**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

Brittany Bruggeman, MD, highlights the importance of newer, easier-to-use glucagon formulations in treating severe hypoglycemia in patients with type 1 diabetes.

New glucagon formulations simplify emergency treatment for type 1 diabetes patients

Brittany Bruggeman, MD, a pediatric endocrinologist at the University of Florida and type 1 diabetes (T1D) physician scientist, highlighted crucial advancements in diabetes management, particularly regarding the use of glucagon for severe hypoglycemic events. 

Bruggeman emphasized the critical importance of having glucagon readily accessible for patients with T1D. “Glucagon is what I like to think of as the EpiPen of diabetes, and so it's very important that everybody with T1D, or even type 2 on insulin, has glucagon immediately available to them,” she said during an interview at the 

2024 American Academy of Pediatrics National Conference & Exhibition.

Recent developments in glucagon formulations have made it much easier to administer, especially in emergency situations. Bruggeman noted that older versions required users to mix a powder and liquid before injection, a process that could be confusing and time-consuming. “What we used to have to do is mix a powder and a liquid together before injecting the person with glucagon, which made it really tough for people in the lay public to know how to use this, and even, like school nurses and things, had to have special trainings,” she explained.

However, new formulations of glucagon have simplified the process, making it more accessible to non-medical personnel. “Now there's a formulation that is a nasal spray, and so literally, you just spray the powder into the person's nose,” Bruggeman said, highlighting how this change has improved usability. Additionally, there are now shelf-stable liquid versions of glucagon that function similarly to an EpiPen, allowing for a quick injection without needing to mix anything. 

Bruggeman stressed the importance of awareness among healthcare professionals and the public regarding these advancements. “It's really important that the lay public, pediatricians, [and] everyone knows about glucagon, and that if someone with T1D is on insulin, they need to have access to this in order to treat them if they had a severe hypoglycemic event,” she said.

Brittany Bruggeman, MD, highlights the importance of newer, easier-to-use glucagon formulations in treating severe hypoglycemia in patients with type 1 diabetes. 

News

New glucagon formulations simplify emergency treatment for T1D patients

Brittany Bruggeman, MD, emphasizes that many patients with type 1 diabetes are unaware of the availability of advanced technologies like CGMs and automated insulin delivery systems.

Communicating availability of continuous glucose monitors for type 1 diabetes patients

Brittany Bruggeman, MD, pediatric endocrinologist at the University of Florida and type 1 diabetes physician scientist, joined 

 to discuss the latest advances in technology for type 1 diabetes care. According to Bruggeman, “there are so many new aspects of technology that we now use routinely in type 1 diabetes,” highlighting the significant role of continuous glucose monitors (CGMs) and automated insulin delivery systems.

Bruggeman emphasized the convenience and effectiveness of CGMs, which allow patients to monitor blood glucose levels without frequent finger sticks. “People can rely on continuous glucose monitors for care and not have to do a finger stick, except for in very special circumstances," Bruggeman noted, adding that this gives both endocrinologists and patients peace of mind with round-the-clock monitoring. 

Another important advancement discussed was automated insulin delivery systems, where insulin pumps and CGMs work together to automatically adjust insulin levels based on real-time blood glucose data. These systems, Bruggeman explained, are crucial for patients on insulin, yet many are unaware of their availability. She stressed the importance of ensuring all patients with diabetes have access to these technologies, stating, “Something important that every patient with diabetes on insulin needs to know is that these systems are available to them." 

Bruggeman also pointed out the troubling health care disparities in the adoption of these technologies. Patients from lower socioeconomic backgrounds and minority groups are significantly less likely to use CGMs and automated insulin delivery systems.

“Unfortunately, half the rate of use of these technologies” exists among underserved populations, compared to non-Hispanic, White, more affluent patients. However, Bruggeman emphasized that “even with lower health literacy or lower socioeconomic status, people really can understand these new technologies.” She concluded that the design of these devices has become more intuitive, making them accessible to a broader population. As Bruggeman put it, “If you can use a phone, you generally can use most of these new technologies.” 

Brittany Bruggeman, MD, emphasizes that many patients with type 1 diabetes are unaware of the availability of advanced technologies like CGMs and automated insulin delivery systems. 

Brittany Bruggeman, MD, highlighted the ability to predict type 1 diabetes months to years in advance through islet autoantibodies.

Testing for islet autoantibodies to monitor type 1 diabetes development

At the 2024 American Academy of Pediatrics National Conference & Exhibition, Brittany Bruggeman, MD, a pediatric endocrinologist and type 1 diabetes physician scientist, University of Florida, provided key updates on the evolving care for type 1 diabetes. Her talk, titled "What’s New in Type 1 Diabetes Care," highlighted significant advancements in both technology and treatments that general pediatricians should be aware of. 

"There’s a lot that is new in type 1 diabetes care," Bruggeman emphasized. Given the rapid pace of these developments, she noted that general pediatricians, who "have to know a little bit about everything," would benefit from updates on the latest advances in managing the condition. 

One of the major points Bruggeman discussed was the importance of early detection in pre-type 1 diabetes. "We can actually tell that someone is going to develop type 1 diabetes months to years before they actually get type 1 diabetes, and we do that through something called islet autoantibodies," she said. These markers allow for early identification of individuals at risk, particularly those with relatives who have type 1 diabetes. 

"There is a new treatment called teplizumab that is an immune therapy that we can actually give in stage 2 type 1 diabetes to help delay the onset of clinical disease," she explained. This innovation provides a new avenue of care, offering hope for delaying the disease’s progression. 

Related: Teplizumab effectiveness in adolescents with newly diagnosed type 1 diabetes

"We’re seeing people who already have the disease," she noted. General pediatricians play a crucial role in screening for risk factors and initiating conversations about islet autoantibody testing. "That’s where the general pediatrician really comes in," she emphasized, as they can identify individuals with a family history of type 1 diabetes and refer them for further testing. 

In summary, Bruggeman’s session highlighted the growing importance of early detection and the use of new treatments, like teplizumab, in delaying the progression of type 1 diabetes. These updates underscore the vital role of pediatricians in identifying at-risk individuals and providing them with timely interventions. 

Brittany Bruggeman, MD, highlighted the ability to predict type 1 diabetes months to years in advance through islet autoantibodies, and how the pediatrician can play a role. 

Video Series

In this video discussion, David Turkewitz, MD, offers clinical pearls to reduce the risk of SIDS and reviews updated 2022 guidelines from the AAP. 

Reviewing the AAP's sudden infant death syndrome 2022 guidelines

David Turkewitz, MD, medical director of Newborn Nurseries at Allegheny Health Network in Pittsburgh, Pennsylvania, emphasized the critical role of pediatricians in educating families about strategies to prevent sudden infant death syndrome (SIDS) and sudden unexpected infant death (SUID). He underscored the importance of staying informed about the latest guidelines to better support families during well-infant visits. 

“Parents depend on pediatricians for advice to keep their children safe and healthy,” Turkewitz said. He noted that the 

2022 American Academy of Pediatrics (AAP) policy statement

 provides a comprehensive roadmap for preventing sleep-related infant deaths. 

“Prior to 1994, infant sleep-related deaths were all lumped into the category of sudden infant death syndrome,” Turkewitz explained. Advances in research and a better understanding of contributing factors have led to more nuanced classifications and targeted prevention strategies.

One critical recommendation highlighted in the guidelines is the importance of always placing infants on their backs to sleep. “Every baby is put on their back to sleep, every nap and for every evening. That one strategy… reduces SIDS more than 50%,” Turkewitz said.

He also emphasized the need for a safe sleep environment, advising parents to use a flat, firm surface for their infants. “While a soft mattress might be appropriate for an adult, it’s totally inappropriate for a baby,” he said.

Breastfeeding was another key preventative measure Turkewitz discussed, highlighting its benefits beyond infection reduction. “One of the more powerful benefits of breastfeeding is SIDS reduction,” he noted.

The guidelines also recommend room sharing, but not bed sharing, to create the safest sleep environment for infants. “The safest area for a baby to sleep is in a parent’s room,” Turkewitz said. "So again, just just having the baby sleep in another area, even if it's in an appropriate crib, dramatically increases its [SIDS risk]." 

Additionally, Turkewitz pointed to pacifier use starting at 2 weeks of age as an effective strategy. While the exact mechanism is uncertain, he said, “evidence-based literature is very clear cut” that pacifier use significantly reduces the risk of sleep-related deaths. 

Turkewitz cautioned against the use of unapproved devices or monitors, noting, “If it’s not government approved, don’t go there,” he advised.

He encouraged clinicians to familiarize themselves with the 2022 AAP guidelines, describing the document as “a great condensation of a tremendous amount of information.”

Moon RY, Carlin RF, Hand I. The task force on sudden infant death syndrome and the committee on fetus and newborn; Sleep-related infant deaths: Updated 2022 recommendations for reducing infant deaths in the sleep environment. 

. July 2022; 150 (1): e2022057990. 10.1542/peds.2022-057990 

In this video discussion, David Turkewitz, MD, offers clinical pearls to reduce the risk of SIDS and reviews the updated 2022 guidelines from the AAP. 

Leah K. Middelberg, MD, FAAP

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