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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

Mary Koslap-Petraco highlighted the need to address vaccine hesitancy, catch up on immunizations, and build trust with parents at the 2025 NAPNAP National Conference on Pediatric Health Care. 

2025 immunization update: addressing vaccine hesitancy and catch-up vaccinations

At the 2025 NAPNAP National Conference, Maureen Madden, DNP, CPNP-AC, CCRN, FCCM, FAAN, explained why the yearly conference is important for both providers and pediatric patients.

NAPNAP conference provides voice for pediatric care

 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.

If approved, SYD-101 would be the first and only pharmaceutical option for the treatment of progression of pediatric myopia in the United States.

FDA accepts NDA for SYD-101 to treat pediatric myopia

Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, reacts to the recent cancelations of the ACIP and VRBPAC and comments on the potential down stream effects. 

How canceled government agency meetings could impact vaccination schedules, with Mary Koslap-Petraco, DNP

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Authors

A pediatric health system discontinues MRSA contact precautions with sustained infection control success, supporting broader consideration while emphasizing the importance of horizontal prevention measures. 

Discontinuing contact precautions for pediatric patients with methicillin-resistant Staphylococcus aureus

**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

Baricitinib, an oral Janus kinase (JAK) inhibitor, demonstrated significant hair regrowth in adolescents with severe alopecia areata (AA), according to 36-week results from a phase 3 trial presented at the 2025 American Academy of Dermatology (AAD) Conference. The study, known as BRAVE-AA-PEDS, was sponsored by Eli Lilly and Company and involved 257 adolescents aged 12 to under 18 years. 

Alopecia areata is an autoimmune disorder causing hair loss, often impacting young patients' self-esteem and quality of life. Approximately 40% of patients experience their first onset during childhood or adolescence, making effective treatment options crucial. While baricitinib is already approved for adult AA and for atopic dermatitis in children aged 2 and above, its efficacy and safety in younger patients with AA had not been fully explored.

The BRAVE-AA-PEDS trial was a randomized, placebo-controlled study evaluating two dosages of baricitinib (2 mg and 4 mg) against a placebo. Participants were required to have a Severity of Alopecia Tool (SALT) score of 50 or higher, indicating substantial hair loss, and a history of unsuccessful treatment attempts. The primary goal was to determine the proportion of patients achieving a SALT score of 20 or less, representing significant hair regrowth.

At the 36-week mark, 42% of adolescents receiving the 4 mg dose of baricitinib achieved a SALT score of 20 or less, compared to just 2% in the placebo group. The 2 mg dose also showed effectiveness, with 21% of patients reaching the primary endpoint. Additionally, the higher dose led to 60% of patients achieving at least a 50% improvement in SALT scores, while the lower dose reached 37%. In contrast, only 5% of those on placebo showed similar improvement.

Eyebrow and eyelash regrowth were also notably higher in the baricitinib groups. By week 36, 43% of patients on the 4 mg dose experienced significant eyebrow regrowth, compared to 14% in the placebo group. Eyelash regrowth followed a similar pattern, with 50% of patients on the higher dose showing improvement versus none in the placebo group.

"Both the efficacy and safety results are unbelievably exciting.," said Brittany Craiglow, MD, board certified, pediatric, adolescent dermatology, in an interview with

She added, "Alopecia areata can be an absolutely devastating disease for patients of any age, but adolescence is already an especially vulnerable time. Many of our patients experience bullying, social withdrawal and even thoughts of self-harm, and this disease can truly alter the trajectory of one’s life. Having a safe and effective treatment option with a legacy of use in pediatric patients as young as age 2 for other indications will be life-changing for so many patients and their families."

The safety profile of baricitinib was consistent with previous studies in adults and children with atopic dermatitis. Treatment-emergent adverse events (TEAEs) were reported in 65.5% of patients receiving baricitinib, compared to 53.4% in the placebo group. Most TEAEs were mild to moderate, with acne, headaches, and upper respiratory tract infections being the most common. Severe adverse events were rare, with no reports of deaths, malignancies, or major cardiovascular events. One serious infection, a case of non-complicated appendicitis, was reported and resolved within five days.

Despite recent approvals of other JAK inhibitors for adolescents, an unmet need for effective treatment options for severe AA remains. The trial’s findings suggest that baricitinib could become a valuable option for this population, offering significant hair regrowth and an acceptable safety profile. Long-term extension studies are ongoing to evaluate the durability and safety of these results beyond 36 weeks.

"Currently there is only one FDA-approved treatment for adolescents with severe AA – ritlecitinib," said Craiglow. "If approved, baricitinib will provide another option for patients in this age group. We are seeing in clinical practice that patients have different responses to different JAK inhibitors, so this will be a welcome addition to our treatment armamentarium. The highly favorable safety profile of baricitinib and history of use in very young patients for other diseases will provide added confidence to prescribers." 

Passeron T, Soung J, Kwon O, et al. Baricitinib Provides Significant Hair Regrowth in Adolescents With Severe Alopecia Areata: 36-Week Efficacy and Safety Results From a Phase 3 Randomized, Controlled Trial. Presented at the 2025 American Academy of Dermatology (AAD) Conference. Orlando, Florida.

The study, known as BRAVE-AA-PEDS, was sponsored by Eli Lilly and Company and involved 257 adolescents aged 12 to under 18 years. 

News

Baricitinib shows promise for adolescent alopecia areata in phase 3 trial

In December 2024, the American Academy of Pediatrics (AAP) 

introduced updates to the critical congenital heart disease (CCHD)

 screening algorithm to enhance efficiency and accuracy in newborn screenings. These changes include a simplified process that reduces the number of retests and refines the criteria for passing oxygen saturation levels. The goal of these refinements is to decrease misinterpretation, improve sensitivity, and ensure more consistent implementation of CCHD screening across hospitals nationwide.

In this quiz, we test your knowledge of the key changes in the screening algorithm.

Take the quiz below to test your comprehension of the updated screening process and its implications for clinical practice.

B) Family history of congenital heart disease

C) Pre- and post-ductal oxygen saturation readings

A) Eliminating mandatory screening in low-risk infants

B) Requiring manual entry of all results into paper logs

C) Integrating screening protocols into electronic health records (EHRs)

D) Conducting screening only for infants with concerning prenatal ultrasounds

In this quiz, we test your knowledge of the AAP's new algorithm and updated recommendations for newborn screening for critical congenital heart disease.

Quiz: Critical congenital heart disease screening data collection, implementation

 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. 

 on Monday, February 24, 2025 at 10:00 PM ET or later for the full case presentation, differential diagnoses, and the correct patient diagnosis. 

This case was provided by Irene Chern, MD, Aimee Johnson, MD, and Dana Toib, MD.

A 6-day-old male with history of waxing and waning urticarial rash presents to the general pediatrician’s office for evaluation. The parents describe the rash as red, raised skin lesions that become flat and congregate, lasting several hours to days, resolving without leaving marks and then appearing in new areas. The rash began shortly after birth, and it does not seem to bother the patient. The parents deny any other concerns, including vomiting, fever, joint swelling, oral ulcers, or irritability. The patient is breastfeeding well and has normal urination and bowel movements.

On review of the nursery notes, it appears that at 9-hours of life the patient developed a rash that started as small, blanching, erythematous, circular macules on the legs; gradually increasing in size and number; becoming raised and coalescing to large, diffuse patches on the legs, back, chest, face, and soles that resolved within several hours. The patient was born to a 30-year-old gravida 1 mother at 40-weeks gestation via spontaneous vaginal delivery. The parents are without consanguinity or family history of autoimmune or inflammatory diseases. The pregnancy was complicated by maternal hypothyroidism and group B Streptococcus positive status, with the mother adequately treated with levothyroxine and intrapartum antibiotics.

Neonatal Onset Multisystem Inflammatory Disease

Click here for the full article featuring the complete case presentation, differential diagnosis, and correct patient diagnosis.

For more puzzler case studies, click here.

Can you diagnose this patient in our most recent puzzler poll? 

Case Studies

Puzzler poll: Urticarial rash in a 9-hours-old male 

 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.

on Monday, January 6 at 12:00 PM ET for the full case presentation, differential diagnoses, and the correct patient diagnosis. 

This case was provided by Amar Davé, MD, FAAP and Pahroul Davé, APRN

A boy aged 10 years presented to the outpatient office with a history of painful nodules on the plantar surface of his bilateral feet 8 to 10 hours after spending time in a hot tub. He was unable to bear weight or put on socks and shoes due to his pain. The photos were taken soon after the painful and red papules appeared. The lesions affected the whole plantar aspect of both feet. Over the following 4 days, the nodules became less painful and red. 

Medical advice was sought on the fifth day of symptoms, and by this time, the child was improving clinically. He was stable with subcutaneous, mildly painful, fleshy nodules mostly populating the medial arch of the foot. His remaining clinical examination results were within a normal range. Further questioning of the child’s mother revealed that other children exposed to the hot tub experienced painful feet but without lesions. 

Due to the patient’s improving symptoms and the self-limiting nature of the illness, no tests or labs were ordered as the child was not acutely ill. No peer consultations or specialists were utilized.

Click here for the full case presentation, differential diagnoses, and the correct patient diagnosis, in a separate article.

The photos in this case were taken soon after the painful and red papules appeared.

Can you diagnose this boy with painful nodules on his feet?

“In some cases, that meant that we could actually go after the primary pathology or the primary cause of the condition in a way that we never would have thought of before."

Benefits of genetic sequencing for cerebral palsy patients

Cerebral palsy (CP) has long been viewed primarily as a condition arising from environmental factors such as birth complications or infections. However, emerging research underscores the significant role of genetics in CP cases, leading to shifts in both diagnosis and treatment approaches. Michael C. Kruer, MD, a pediatric neurologist and human geneticist at Phoenix Children’s Hospital, emphasized the evolving understanding of CP genetics and its implications for clinical care.

“Pediatricians, you know, inevitably find themselves to be the primary advocates for the kids they look after. They're really the gatekeepers for access to specialists,” Kruer explained. With growing evidence supporting the genetic origins of CP, he urges primary care providers to consider genetic evaluations. “CP can, but often has a genetic cause,” he stated, stressing that recognizing this fact is essential for patient advocacy and informed medical decision-making.

A recent study co-authored by Kruer and published in 

 analyzed multiple published cohorts to reassess the genetic basis of CP. The findings were striking: 

“In our study, about 27% of the nearly 2,000 CP patients who underwent exome sequencing had an identifiable genetic cause for their CP." This result aligns with previous research indicating that approximately 1 in 4 individuals with CP have a genetic explanation for their condition. 

Tori Whitacre Martonicz

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