Animal Allergies

Food Allergies

Allergy, Immunology, and ENT

Cardiovascular Diseases

Cardiology

Acne

Atopic Dermatitis

Dermatology

Emergency Medicine

Diabetes

Endocrinology

Formula

Nutrition

Obesity

Gastroenterology

Antibiotic Resistance

Bacterial Conjunctivitis

COVID-19

Influenza

Pneumonia

Sexually Transmitted Diseases

Vaccination and Immunization

Vaccines

Infectious Diseases

ADHD

Addiction

Antisocial Personality Disorder

Anxiety

Autism

Depression

Developmental/Behavioral Disorders

Psychiatry

Mental, Behavioral and Development Health

Concussion

Epilepsy

Headache

Neurology

Neonatal/Perinatology

OB/GYN

Pain

Drug Pipeline News

Pharmacology

Telemedicine

Practice Improvement

Asthma

Cystic Fibrosis

Respiratory

Rheumatology

News 

All News

PNP Corner

AAP News

Media

Around the Practice

Cure Connections

Expert Interviews

Insights

Medical World News

Peer Exchange

Peers & Perspectives

Podcasts

Webinars

Puzzler

Publications

Contemporary Pediatrics Journal

Supplements And Featured Publications

CME/CE

Resources

Handouts

Job Board

Conferences

Conference Coverage

Conference Listing

Partnerships

Subscribe

Editorial

Editorial Advisory Board

Writer’s Guidelines

Reference Guidelines

Meet the Editors

Articles

The most common reactions reported were the following: irritability or fussiness (30.1%), local reactions (21.1%) and fever (13.8%).

No unexpected reactions present among mRNA COVID-19 vaccination in kids

. 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.

Results demonstrated that slowed aperiodic activity was present in brain areas linked to concussion symptoms such as impaired concentration and memory.

Study: Concussions slow aperiodic activity among high school football players

Paul Kruszka, MD, MPH, FACMG, explains for general providers the difference between screening and diagnosis regarding whole genome sequencing and how it could play a role in the primary care setting.

Whole genome sequencing: Screening and diagnosis

In this video interview, Herbert Bravo, MD, explains how implementing autoimmune diabetes screenings in the primary care setting can benefit the child several ways. 

Autoimmune diabetes and preventing diabetic ketoacidosis

About Us

Advertise

Contact Us

Terms and Conditions

Privacy

Do Not Sell My Personal Information

Contemporary Pediatrics

Facebook

LinkedIn

Instagram

Clinical

Gynecology

Infectious disease

Mental Health

Oncology

Rheumatoid Arthritis

Sexual Health

View More

1rem

Authors

You are doing a pediatric nephrology rotation. It is late in the evening, and you're just about to leave for home when your pager goes off. You answer the call and learn about a 5-week-old girl who was seen in the orthopedic clinic that afternoon for developmental dysplasia of the hip (DDH).

A baby's pseudo paralysis of the hip stumps her doctors

**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

Contemporary Pediatrics' editor-in-chief Tina Tan, MD, FAAP, FIDSA, FPIDS, discusses the recent uptick in pediatric vaccine exemptions in this video interview. 

Kindergarten vaccine coverage decreased, exemptions increased in 2023-2024 school year

Tina Tan, MD, FAAP, FIDSA, FPIDS, editor in chief of 

 and professor of pediatrics at Northwestern University’s Feinberg School of Medicine, shared her concerns regarding rising vaccine hesitancy and unwarranted exemptions, emphasizing the importance of immunization in safeguarding public health. 

“The increase in vaccine exemptions, many of them are not valid,” said Tan. “Vaccine hesitancy has definitely increased because vaccines during the COVID era have become politicized. So people believe that the vaccines either aren't effective or they don't trust the new way that vaccines are developed, and that's very unfortunate."

According to an October 2024 edition of the Centers for Disease Control and Prevention's 

, coverage for all reported vaccines declined to less than 93% (range = 92.3% [diphtheria, tetanus, and acellular pertussis vaccine] to 92.7% [measles, mumps, and rubella vaccine]) during the 2023-2024 school year.

During the 2023-2024 school year. the vaccine exemption rate increased to 3.3%, up from 3% the year prior, and increased in 41 jurisdictions. In 14 jurisdictions, rates exceeded 5%.

“It’s really important that everybody get their influenza [vaccine], their COVID booster vaccine, and if they’re eligible, get nirsevimab, the monoclonal antibody [for respiratory syncytial virus( RSV)],” Tan stressed. Additionally, she noted the importance of maternal vaccination before the RSV season as a means to protect newborns.

Reflecting on the broader impact of vaccines, Tan described them as a cornerstone of modern medicine. 

“Vaccines are a public health tool that is one of the greatest public health tools that have ever been developed,” she said. “They have been shown to significantly decrease the transmission of these diseases and protect individuals against getting these diseases.”

Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten — United States, 2023–24 School Year. 

. October 17, 2024. Accessed November 17, 2024. https://www.cdc.gov/mmwr/volumes/73/wr/mm7341a3.htm

Contemporary Pediatrics' editor-in-chief Tina Tan, MD, FAAP, FIDSA, FPIDS, discusses the recent uptick in pediatric vaccine exemptions in this video interview.

News

Paul Kruszka, MD, MPH, FACMG, chief medical officer of GeneDx, joined us to provide background of whole genome sequencing and its benefits. 

Background on whole genome sequencing and review of the GUARDIAN study

Paul Kruszka, MD, MPH, FACMG, chief medical officer at GeneDx and clinical geneticist at Children’s National Hospital, explained the role of genetic testing in improving pediatric care. Speaking on the potential of whole genome sequencing, Kruszka emphasized its value in diagnosing rare diseases earlier and more effectively. 

“One out of 10 people in North America are affected by a rare disease, that’s 30 million people in the [United States],” Kruszka noted, highlighting the prevalence of rare genetic conditions. “There is a lot of genetic rare disease. So certainly, this is in the wheelhouse of a general pediatrician and all the pediatric sub-specialties, whether you’re a neonatologist, a pediatric neurologist, [or] a developmental pediatrician.”

Kruszka detailed the GUARDIAN study (NCT05990179), a multisite, single-group, prospective, observational investigation of supplemental newborn genome screening, in which data has been reported on the first 4000 families that have participated across 11 months. Data were from newborns in 6 New York City hospitals between September 2022 and July 2023.

“We used targeted whole genome sequencing to expand the newborn screening for more rare diseases," said Kruszka, who is also a GUARDIAN study investigator. "Typically, we screen for 30 to 60 conditions. With the GUARDIAN study, we bumped that up to almost 250 conditions. These are diseases that are treatable, actionable.”

The study objective was to report interim results of acceptability, feasibility, and outcomes of an ongoing genomic newborn screening in a diverse population, with the primary endpoint being screen-positive rate.

“Some examples that we found: there were children with long QT syndrome that we found. This is treatable with medications such as beta blockers. This is a cause of sudden cardiac death in children,” Kruszka said. “We found another child who required a bone marrow transplant. We found severe combined immune deficiency in another child before symptoms started that was missed by typical newborn screening.” 

In the study, testing was completed successfully for 99.6% of cases, with a screen-positive rate of 3.7%, which included treatable conditions that are not currently included in newborn screenings, according to study results.

“This is identifying kids that would have taken, on average, 6 years to be diagnosed,” Kruszka said. “The idea behind this study is really to eliminate the diagnostic odyssey, to give diagnoses before symptoms even start, to prevent damage, [and] to allow for better health outcomes.” 

“It’s unacceptable to wait 1–2 years to see a clinical geneticist or have a genetic test. There’s no reason for that," he said while expressing hope that the GUARDIAN study would inspire change. 

“This is a long time coming… It’s more important than ever for all of us in the pediatric community to understand genetics [and] genomics," said Kruszka. “Our newborn screening system is fantastic, but it only really captures a slice of rare disease. With whole genome sequencing, we’re opening up a whole new spectrum of diseases that we’re going to be able to identify early.” 

Paul Kruszka, MD, MPH, FACMG, has the following disclosures

Employment - Chief medical officer at GeneDx 

Ziegler A, Koval-Burt C, Kay DM, et al. Expanded Newborn Screening Using Genome Sequencing for Early Actionable Conditions. 

 Published online October 24, 2024. doi:10.1001/jama.2024.19662 

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

Prenatally substance-exposed infants and SUID outcomes, preventive recommendations

It it known that maternal substance use during pregnancy increases risk of sudden unexpected infant death (SUID), including via unsafe sleep practices. Authors of a study published in 

 sought to indentify targeted prevention opportunities by comparing characteristics of sleep-related SUID among infants born prenatally substance exposed versus nonexposed.

Lead study investigator Stephanie Anne Deutsch, MD, MS, MSCR, FAAP—medical director, Children at Risk Evaluation (C.A.R.E.) Program, Nemours Children's Health, Wilmington, Delaware—joined 

to highlight the study and explain recommendations and preventive measures for families impacted by substance use. Such families, according to the authors, frequently experience disproportionate social drivers of poor health and family vulnerability likely contributory to fatality risk. 

"At the local level, I am involved in child fatality review processes in the Delaware Valley region, and we were noticing a trend of increasing SUID among infants that had a history of prenatal substance exposure and concerning circumstances amongst those deaths, including report potentially of caregiver impairment," said Deutsch. "That inspired us to look at this topic at the national level and obtain data from the National Center for Fatality Review and Prevention through their case reporting system."

Using the Sudden Death in the Young Registry, Deutsch and investigators examined SUID with sleep-related death between 2015 and 2020 across infants prenatally exposed versus nonexposed. Distribution of sleep environment characteristics, social drivers of poor health, and family vulnerability factors were examined using descriptive statistics and χ

Among 2010 infants who experienced sleep-related deaths, 14% (n = 283) were prenatally exposed. Over half (52%; n = 1045) of deaths involved an adult bed or surface sharing (53%, 

"When we looked specifically at the data, dichotomized by prenatally substance exposed infants versus nonexposed infants, we identified that supervisors of prenatally exposed infants were disproportionately impaired versus supervisors of nonexposed peers [(34%, n = 97 vs 16%, n = 279)]," said Deutsch. "Most prenatally exposed infants whose supervisors were impaired were also bed sharing at the time of the infant death event." 

Overall, 1 in 4 deaths of prenatally exposed infants (n = 70) involved child death review-determined supervisors who were both impaired and bedsharing.  

Based on study findings, Deutsch and authors concluded that sleep-related SUID in prenatally exposed versus non exposed differ in sleep environment characteristics and contributory social vulnerability. Sleep evnironment hazards for those prenatally exposed "should compel targeted prevention efforts, including safe sleep messaging, discouraging surface sharing, and engaging support persons during impairment periods," wrote the study authors.

"Experts have long suggested that there is a need to provide greater emphasis on safe sleep practices and education for families impacted by substance use, and part of that stems from early studies that were conducted looking at relationship between substance use, caregiver impairment, intoxication, and then potentially placement of that infant into a hazardous environment," Deutsch said in the interview. "So here, we really feel that families of infants born prenatally, substance exposed, may benefit from de-stigmatized and targeted SUID prevention efforts, including specific counseling and anticipatory guidance that discourages surface sharing and that calls for potential engagement of a nonimpaired caregiver at the time the infant may be sleeping, in order to reduce any sort of hazards in the sleep environment."

"We think that safe sleep counseling is very important to be reinforced as anticipatory guidance at every well child visit, but there may be particular guidance that's necessary for families impacted by substance use, as we know, these families may also experience multiple psychosocial adversities that may relate to the substance use, including socioeconomic stressors impacted access to healthcare, education, and mental health treatment services," added Deutsch. "This may also result in limited material access, for example, to an infant safe sleep space like a crib or bed. So it's important for pediatricians to keep in mind that their counseling also addresses the social drivers of health, in addition to that safe sleep messaging."

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.

Deutsch SA, Loiselle CE, Hossain J, De Jong A. Sleep-Related Sudden Unexpected Infant Death Among Infants Prenatally Substance Exposed. 

. 2024; e2024067372. 10.1542/peds.2024-067372 

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

H. Westley Phillips, MD, pediatric neurosurgeon-scientist at Stanford Medicine Children’s Health, discussed advancements in surgical options and neuromodulatory technologies for treating pediatric drug-resistant epilepsy, in the 

video interview. He emphasized the importance of early referrals and the hope these innovations bring to patients and families.

Drug-resistant epilepsy can have major neuropsychological consequences on the developing brain, and that after failing two or more medications, the haste in which patients are evaluated for surgery really can dictate outcomes,” stated Phillips. 

S Paul Hmiel, MD, PhD

Articles

Latest Updated Articles