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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

The expanded indication is approved to reduce excess body weight and maintain reduction long-term in children 2 years and up with obesity due to BBS, POMC, or LEPR deficiency.

FDA expands setmelanotide indication to patients as young as 2 years

"Tapinarof comes in with that mixture of the short-term studies and longer-term studies intermittently, giving us a nice, effective alternative non-steroid for eczema across the ages." 

Lawrence Eichenfield, MD, talks tapinarof cream, 1%, nemolizumab FDA approvals for atopic dermatitis

The primary endpoint was non-inferiority in HbA1c levels after 26 weeks. 

Afrezza inhaled insulin meets primary endpoint in phase 3 pediatric diabetes trial

Donna Hallas, PhD, PPCNP-BC, CPNP, PMHS, FAANP, FAAN, highlights the latest issue of Contemporary Pediatrics. 

Screen use and ways to protect pediatric eyesight

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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

A discussion of the evolving landscape of diabetes technology and its implications for primary care providers. 

Keeping up with endocrinology changes in primary care

Greg Forlenza, MD, a pediatric endocrinologist at the Barbara Davis Center for Diabetes at the University of Colorado, discussed the rapid advancements in diabetes technology and how pediatricians can better support care for children with type 1 diabetes. 

“In pediatric endocrinology, when we’ve looked at this, we found that over 90% of kids in the United States who have type 1 diabetes are seen by a pediatric endocrinologist,” Forlenza said. He added that this is different from adult diabetes care, which is split among endocrinologists, family medicine, and internal medicine providers.

Forlenza highlighted the fast-paced nature of the field. “In most of medicine, if you’re reading a 5-year-old article, you’re reading something that’s pretty accurate for your field. Whereas in my talks, when I talk about technology, I’ll put something up and be like, this slide is 2 years old. This is super outdated. Most of my stuff is within the last 6 months.” He noted that the speed of advancements makes it challenging for those not immersed in diabetes technology to stay current, but it underscores the importance of advocacy for patient care.

“In the last 5 years, we’ve gone to everyone starts CGM, ideally within the day of diagnosis to the week of diagnosis,” Forlenza explained. He added, “From there, we’re aiming to have people be on automated insulin delivery systems within the first 1–3 months.” He noted that some patients still fall through the cracks, and pediatricians play a critical role in identifying and addressing gaps in care. “If I’m seeing someone that’s not on CGM, this is behind standard of care. Maybe you need to talk to them, see what kind of barriers they’re encountering, make sure that they’re advocating for themselves to be on it.” 

Forlenza also discussed a shift in the approach to technology adoption. “We’re moving more towards an opt-out, rather than an opt-in phenomenon, which we believe helps reduce disparities long term.” Pediatricians, he said, can help bridge gaps in care by ensuring patients are referred to the appropriate resources and are on track with current diabetes management standards. 

A discussion of the evolving landscape of diabetes technology and its implications for primary care providers.

News

Keeping up with type 1 diabetes technology changes in primary care

In this episode, the panel discusses therapies and care around inpatients including mechanical ventilation, extracorporeal membrane oxygenation (ECMO), and remdesivir.

COVID-19 Therapy Roundtable: Focusing on Inpatient Care

According to the Centers for Disease Control and Prevention, the week ending November 30, 2024, there has been a rate of 0.8 hospitalizations per 100,000 people, and this shows a good downward trend over the last few weeks.

Although the number of hospitalizations have decreased significantly since the beginning of the pandemic, there are waves where incidence rates increase and a number of people who are contracting severe cases of COVID-19 who need to be hospitalized.

During the height of the pandemic and before the development of vaccines and therapies, there were therapeutic limitations and patients could be put on extracorporeal membrane oxygenation (ECMO).

ECMO was utilized more frequently in a time when there was not other treatments. And in some select cases, James Wilson, DO, FACP, FAWM, CTropMed, says ECMO did show some benefit, and there might be some select situations where it might be warranted but overall he says treatment protocols have changed considerably since 2020. 
“If they're breathing at 40 times a minute for more than an hour, you're going to have to do it [ECMO],” Wilson. “But now we have modalities to treat those patients.”

One of the treatments that has emerged has been remdesivir for inpatients with severe COVID-19.

“I triage COVID between requiring oxygen and not requiring oxygen,” said Scott Roberts, MD, associate medical director of Infection Prevention, Yale School of Medicine. “And then once you become severe enough to require it, we really start remdesivir as soon as we can in the inpatient setting. And weknow from many studies at this point there are reductions in mortality in those who do receive remdesivir. We use it for all really severe patients.” 



This is episode 2 of our 4-part series. Check back for future episodes. 

1. COVID Tracker. CDC. Accessed December 10, 2024.

https://covid.cdc.gov/covid-data-tracker/#covidnet-hospitalization-network

In this episode, the panel discusses therapies and care around inpatients including mechanical ventilation, extracorporeal membrane oxygenation (ECMO), and remdesivir. 

COVID-19 Therapy Roundtable:  focusing on inpatient care 

® website. Take a look at some of our top stories from last week (Monday, December 2, to Friday, December 6, 2024), and click on each link to read and watch anything you may have missed.

COVID-19 Therapy Roundtable: Defining the Virus Today and Treatment Options

Click the link below and watch our first episode of our COVID-19 Therapy Roundtable discussion, in collaboration with our sister publications 

. Our panels of experts highlight different therapies around COVID-19 treatment and prevention, and offer practical clinical pears surrounding the infectious disease.

Tina Tan, MD, professor of Pediatrics, Feinberg School of Medicine, Northwestern University 

Scott Roberts, MD, associate medical director of Infection Prevention, Yale School of Medicine

James Wilson, DO, FACP, FAWM, CTropMed, critical care physician in private practice 

Michael Curulewski, PharmD, BCPS, BCIDP, BCGP infectious diseases and antimicrobial stewardship pharmacist, Endeavor health, Northwest Community Hospital 

Our next episode of this roundtable series will be posted Wednesday, December 11 on 

Click here to watch the first episode, which runs 11 minutes.

Fremanezumab for episodic migraine prevention demonstrates positive phase 3 data 

Teva Pharmaceuticals has reported positive phase 3 results for fremanezumab (Ajovy) in preventing episodic migraine in children and adolescents aged 6 to 17 years. The SPACE trial (NCT04530110), a 12-week, randomized, placebo-controlled study, demonstrated significant efficacy compared to placebo and a safety profile consistent with adult populations. 

Key findings include a reduction in monthly migraine days (-2.5 vs -1.4; P = 0.0210), monthly headache days (-2.6 vs -1.5; P = 0.0172), and a higher proportion of patients achieving a ≥50% reduction in migraines (47.2% vs 27.0%; P = 0.0016). Benefits were consistent across age groups and genders. The safety profile was favorable, with adverse event rates comparable between fremanezumab (55%) and placebo (49%), and low discontinuation rates (≤1%).

This milestone addresses the rising incidence of pediatric migraines, which affects up to 15% of adolescents but has seen limited innovation in treatment options. Fremanezumab, already approved for adult migraine prophylaxis, is the first CGRP-pathway treatment to demonstrate statistically significant efficacy and safety for episodic migraine prevention in pediatric patients. Further studies are ongoing to assess its use in chronic migraines and long-term safety. 

FDA grants Rare Pediatric Disease to 101-PGC-005 for systemic juvenile idiopathic arthritis

PIF Partners has announced that its investigational therapy 101-PGC-005 ('005) has received Rare Pediatric Disease Designation from the FDA for systemic juvenile idiopathic arthritis (sJIA) flares. The treatment, a Type IA prodrug of dexamethasone targeting CD206+ macrophages, is also undergoing phase 3 trials in India for COVID-19-induced acute respiratory distress syndrome.

Systemic juvenile idiopathic arthritis is a rare, severe autoinflammatory disease affecting children under 16, characterized by spiking fevers, rash, joint inflammation, and organ involvement. The FDA's designation promotes the development of treatments for serious pediatric diseases, reflecting '005's potential to address the unmet needs in sJIA. 

Upadacitinib effective in treating atopic dermatitis through 76 weeks

In a study that assessed 3 randomized clinical trials of adolescents with moderate-to-severe atopic dermatitis (AD) who were treated with upadacitinib, results demonstrated sustained efficacy responses through 76 weeks to go along with a favorable safety profile. These results were published in 

In the Measure Up 1 (NCT03569293), Measure Up 2 (NCT03607422), and AD Up (NCT03568318) trials—ongoing, double-blind, placebo-controlled phase 3 randomized clinical trials featuring adolescents aged 12 to 17 years with moderate to severe AD—once-daily upadacitinib, 15 mg or 30 mg, was superior to placebo alone (Measure Up 1 and Measure Up 2 trials) or with topical corticosteroids (AD Up trial) through 16 weeks, and was sustained through 52 weeks during blinded extension phases of the studies.

To further evaluate the once-daily JAK inhibitor, the study investigators sought to assess the efficacy of upadacitinib, 15 mg and 30 mg, with or without topical corticosteroids, in the same patient population through 76 weeks.

Click here for study results and full data points.

J&J submits applications for guselkumab to treat plaque psoriasis, jPsA in children

A pair of supplemental Biologics License Applications (sBLAs) have been submitted to the FDA for Johnson & Johnson's guselkumab (Tremfya) to treat moderate-to-severe plaque psoriasis (PsO) in children aged 6 years and up and to treat active juvenile psoriatic arthritis (jPsA) in children aged 5 years and older, Johnson & Johnson recently announced.

According to the announcement, the PsO submission is backed by data from the phase 3 PROTOSTAR study (NCT03451851) that featured pediatric patients with moderate-to-severe plaque PsO. In addition, the submission is based on bridging pharmacokinetic (PK) data from the phase 3 Voyage 1 (NCT02207231) and Voyage 2 (NCT02207244) studies in adult patients.

Get caught up with Contemporary Pediatrics! This list helps you navigate our top stories from the week, all in one place. 

Weekly review: COVID-19 roundtable, upadacitinib data for AD, and more

In our latest roundtable series, we cover different therapies around COVID-19 treatment and prevention. 

The Centers for Disease Control and Prevention (CDC) views COVID-19 asan endemic virus.

Essentially it is circulating inperpetuityand we will witnessebbs and flows in prevalence.And certainly during the holiday season, respiratory virus incidence rates can increase due to a number of factors including families and friends gatheringtogether, travel increases, and people are in closed environments because of the winter climate. 
All clinicians, public health officials, and interested stakeholders will always stress the importance of vaccination as the best way to prevent or reduce the severity of COVID-19. Inevitably, people will get infected, especially as the statistics for vaccination are down. 
A recent CDC MMWR report published a few weeks ago offered insights on the vaccination statistics so far into the respiratory virus season. “As of November 9, 2024, cumulative estimated coverage with 2024–2025 influenza and COVID-19 vaccines among adults aged ≥18 years was 34.7% and 17.9%, respectively. Estimated RSV vaccination coverage was 39.7% among adults aged ≥75 years and 31.6% among those aged 60–74 years at increased risk,” the authors wrote.

  
In this first roundtable episode, the panel touch upon what COVID-19 is at the end of 2024, offers insights on FDA approved antivirals, and the limited treatment options in the pediatric population. 

Tina Tan, MD, professor of Pediatrics, Feinberg School of Medicine, Northwestern University

In our latest roundtable series, we cover different therapies around COVID-19 treatment and prevention.

Leah K. Middelberg, MD, FAAP

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