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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

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

Weekly review: Multiple FDA approvals, expert discussions and more

Fitusiran is administered subcutaneously starting once every 2 months for patients aged 12 years and older with hemophilia A or hemophilia B, with or without factor VIII or IX inhibitors. 

FDA approves fitusiran for hemophilia A, B patients aged 12 years and up

 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.

A look ahead to 5 key regulatory decisions scheduled to take place during the second quarter of 2025, from a monoclonal antibody to topical psoriasis treatments. 

5 pediatric FDA decisions to watch for in Q2 2025

Mesoblast's remestemcel-L (Ryoncil) was approved by the FDA on December 18, 2024 to treat SR-aGVHD in patients 2 months and older. Now, it is available for purchase. 

Remestemcel-L now available to treat steroid-refractory acute graft-versus-host disease

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When a baby is born with a disfiguring port wine stain, parents may be anxious for options to eliminate the lesion. Laser treatment is an effective option, and it is best begun early.

Port wine stains in infants: Optimizing outcomes with early treatment

**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

Recent research detailed that a child was most likely to be killed in a mass shooting by a parent or family member vs a stranger or peer. Study investigator Stephanie Chao, MD, breaks down these data. 

Stephanie Chao, MD details relationships in mass shootings involving children

Stephanie Chao, MD, FACS, FAAP, associate professor of Pediatric Surgery at Stanford Medicine Children’s Health, has dedicated her research to understanding the true risks of firearm-related mass shootings involving children. Motivated by both her professional expertise and personal experience as a mother, Chao became concerned after her young daughter described an active shooter drill at school.

“She told me, ‘Well, the teacher said, in case there’s a bear outside, this is what we should do,’” Chao recalled. “I just thought that that was incredible in that the teacher had to create a story.” This experience led Chao to question the effectiveness of school-based active shooter drills and examine where the true threats to children exist.

Chao co-authored a recent study published in 

, which analyzed mass shootings involving child victims. The study defined pediatric mass shootings as incidents in which at least 4 people were killed, excluding the perpetrator, and at least 1 of the victims was under 18 years old.

Researchers reviewed 121 incidents between 2009 and 2020, which resulted in 308 child fatalities. The study found that 59.1% of these deaths were perpetrated by a family member, with parents alone responsible for 40.9% of all mass shooting deaths. In contrast, classmates accounted for just 6.8% of child fatalities.

“I was surprised by our findings,” Chao said. “We found in our study that 59% of mass shootings that involved children dying were committed by a relative, and 41% of those shootings were committed by a parent. Only a very small percentage, by comparison, was committed by a classmate.” 

Chao emphasized the role of pediatricians in addressing firearm safety. 

“I think pediatricians are really on the front lines with kids,” she said. “They see all the small booboos, they see the cold, but they also see the things that are the beginnings of lifelong trauma.” However, discussing firearm safety remains a challenge in clinical settings. Chao noted that even seasoned pediatricians find conversations about gun safety uncomfortable and difficult to fit into busy patient visits.

One of Chao’s ongoing research projects, PLEDGE, aims to bridge this gap by developing a school-based curriculum focused on gun safety, safe storage, and mental health awareness. 

“We are trying to create a common vocabulary that is nonpartisan,” she explained. “We need to know how to talk about it starting as children.”

Chao believes that treating firearm violence as a public health issue, rather than a political debate, is crucial for prevention. 

“Gun deaths in our country need to be treated as a public health problem, and the research needs to address it just like we do any other issue,” she said. “It’s not going to be a single solution. It’s going to be multifaceted.”

This month, a new initiative from The Ad Council called "Agree to Agree" was launched at Northwell Health's annual Gun Violence Prevention Forum. The initiative address firearm violence and is the first national cross-sector youth gun violence prevention campaign with a public health approach.

The initiative includes a series of PSAs that feature health care professionals speaking to clinicians about gun violence. Using the trusted relationships that providers have with their patients and families, the initiative aims to drive conversation about gun violence prevention.

1. Stephanie D. Chao, MD FACS FAAP. Stanford profiles. Accessed March 26, 2025. https://profiles.stanford.edu/stephanie-chao 

2. Emengo P, Strope JD, Sabapaty A, et al. Victim-Shooter Relationships in Mass Shootings Involving Child Victims. 

 Published online February 10, 2025. doi:10.1001/jamapediatrics.2024.6609 

3. The Gun Violence Prevention Forum. Northwell Health. Accessed March 26, 2025. https://preventgunviolence.com/ 

News

Tina Tan, MD, FIDSA, FPIDS, FAAP, comments on the FDA's recent selection of the 2025-2026 influenza vaccine compositions, without the CDC's ACIP meeting and FDA's VRBPAC meeting. 

Tina Tan, MD on FDA's 2025-2026 influenza vaccine composition

On March 13, 2025, the FDA announced influenza vaccine virus strain recommendations to vaccine manufacturers for the 2025-2026 influenza season in the United States.

In a press release, the federal agency stated it convened a meeting of members from the FDA, CDC, and Department of Defense (DoD) for an in-depth discussion that informed the selected compositions of the influenza vaccines to be used.

The FDA stated it does not foresee any impact of timing or availability of the vaccines for the American public for next flu season.

 concerns among health care professionals

 that delays in vaccine availability could arise following the postponement of the CDC's Advisory Committee on Immunization Practices (ACIP) meeting, originally scheduled for February 26, 2025.

Shortly after the ACIP meeting was postponed, the FDA's Vaccines and Related Biological Products Advisory Committee (VRBPAC), scheduled for March 13, 2025, was canceled.

According to Tina Tan, MD, FIDSA, FPIDS, FAAP, editor in chief, 

; president, Infectious Diseases Society of America (IDSA), these meetings typically contribute to the FDA's selection of influenza vaccine compositions. This year, however, compositions were selected and announced by the FDA without these meetings having occurred. 

 published on March 20, 2025, the ACIP meeting has been rescheduled for April 15-16, 2025. The publication stated the reason for the initial postponement, according to the Department of Health and Human Services, was to accommodate public comment.

"Basically what was in the document that [the FDA] released about the selection was they just basically took the strains that the [World Health Organization] (WHO) had used, and were going to use those strains to make the vaccines," Tan said in the video above. 

The FDA stated that it used global and United States surveillance data to determine the recommendation for the vaccine manufacturers. These topics included, according to a press release

"Data and information on flu virus strains that are circulating in the US and globally and the types that are causing disease;

Data and information on mid-season vaccine effectiveness for the 2024-2025 vaccines; and 

Information on candidate vaccine virus strains for use in manufacturing flu vaccines for the upcoming flu season."

The federal agency recommended that the trivalent formulation of egg-based influenza vaccines for the upcoming flu season contain:

An A/Victoria/4897/2022 (H1N1)pdm09-like virus; 

An A/Croatia/10136RV/2023 (H3N2)-like virus; and

A B/Austria/1359417/2021 (B/Victoria lineage)-like virus

The FDA recommended that the trivalent formulation of cell- or recombinant-based influenza vaccines contain: 

An A/Wisconsin/67/2022 (H1N1)pdm09-like virus;

An A/District of Columbia/27/2023 (H3N2)-like virus; and

With the recommendations, the FDA also listed the names of the interagency meeting participants from the FDA, CDC, and DoD who collectively made the recommendation. 

"For FDA and for CDC, I did not recognize any names on there, and the individuals [who] are considered [to be] absolute flu experts, were not anywhere on that list," Tan told 

.  "What I found very interesting was that there were several people from the Department of Defense that were on that committee to decide what strain should be included in the vaccine." 

Tan, a former member of VRBPAC (2019-2023

), stated the selection process for the 2025-2026 influenza vaccine composition was not traditional.

"Having sat on VRBPAC, which is the FDA committee that basically reviews surveillance data from the WHO and the CDC to determine what strains are included in the vaccine, I can tell you that you don't just look at WHO's choices and say 'that's what's going to be included,'" said Tan. 

"You have to review all the other scientific information. My concern is the fact that this administration has pulled us out of WHO. So, if this vaccine is not as effective as it could be because they didn't review any other surveillance data, I think this administration will say, 'see, that's why we pulled out of WHO, because you can't trust them, and the flu vaccine is not worth taking,' or 'It's ineffective.'"

Even with the unique situation in which the FDA recommended the influenza vaccine compositions, Tan said vaccination is crucial for protection, especially among a pediatric population.

"We just went through one of the most severe influenza seasons that we've had in decades," she said. "Part of it was the fact that there were so many people that were not taking influenza vaccination. It's a wait and see, but we could see another severe season if we don't get people vaccinated." 

"I still think that having someone vaccinated is better than not being vaccinated, and with the increasing amount of vaccine hesitancy that is occurring, I would just ask all the providers to please take the time and talk to their patients about why it's so important to be vaccinated," added Tan. "Especially for infants and kids, because they can't advocate for themselves." 

Tina Tan, MD, FIDSA, FPIDS, FAAP, comments on the FDA's recent selection of the 2025-2026 influenza vaccine compositions, without the CDC's ACIP meeting and FDA's VRBPAC meeting.

Roy G Geronemus, MD

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