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Management of infantile hemangiomas—experience of a tertiary hospital

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Abstract

The purpose of the study is to describe the experience of a multidisciplinary team in a tertiary hospital regarding the management of Infantile Hemangiomas (IH). The method employed is a retrospective analysis of patients with IH followed in a tertiary pediatric hospital between January 2010 and May 2022. A total of 393 IH were diagnosed (56.7% female), with a median age of 5 months (interquartile range (IQR), 3–10). Imaging investigation was necessary for diagnosis and for exclusion of other IH in 9.2% and 14.3%, respectively. Focal (74.0%) and superficial (59.7%) lesions were more frequent as was facial location (35.9%). Pre-treatment ulceration or hemorrhage occurred in 6.6%. At follow-up, 87.4% regressed partially and 12.6% completely; 2.7% relapsed. Propranolol was started in 30.0% of cases for a median period of 9 months (IQR, 6–12), mainly due to esthetic concerns (41.9%). Side effects occurred in 8.3% (sleep disturbance in 5.1%). Only 1.7% were refractory and 5.9% had a rebound effect. Eleven patients were treated with topical timolol and 41 underwent surgery. Patients that were treated with propranolol had more risk factors (p = 0.016) and presented deeper lesions (p < 0.001) with a larger diameter (p < 0.001); total IH regression was less frequent (p < 0.001). Since 2020, twice-daily dosage was more frequently prescribed than three times daily (p = 0.007) and inpatient initiation of propranolol decreased (p = 0.750), without significant difference in the incidence of adverse reactions, duration of treatment, and lesion evolution.

  Conclusions: Our protocol proved to be safe and feasible in an outpatient setting and twice daily administration of propranolol was effective. The majority of IH showed at least partial regression. Early detection of high-risk IH is paramount and a multidisciplinary assessment by a specialized team is essential for adequate management.

What is Known:

• IH are the most common vascular tumors in childhood. Although the majority evolves favorably, treatment may be warranted in selected cases.

• Early detection of high-risk IH is paramount, and a multidisciplinary assessment by a specialized team is essential for adequate management.

What is New:

• One-third of our sample was treated with propranolol. These patients had more risk factors and presented deeper lesions with a larger diameter, and tumor total regression was less frequent.

• Our results reinforce safety and feasibility of propranolol initiation in an outpatient setting, including twice daily dosage.

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Abbreviations

ECG:

Electrocardiography

IH:

Infantile hemangiomas (IH)

LUMBAR:

Lower body IH, urogenital anomalies/ulceration, myelopathy, bony deformities, arterial anomalies, renal anomalies

MRI:

Magnetic resonance imaging

PHACE:

Posterior fossa anomalies, hemangioma, arterial anomalies, cardiac anomalies, and eye anomalies

References

  1. Munden A et al (2015) Prospective study of infantile hemangiomas: incidence, clinical characteristics, and association with placental anomalies. HHS Public Access 170(4):907–913

    Google Scholar 

  2. Kilcline C, Frieden IJ (2008) Infantile hemangiomas: how common are they? A systematic review of the medical literature. Pediatr Dermatol 25(2):168–173

    Article  PubMed  Google Scholar 

  3. Haggstrom AN et al (2007) Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics. J Pediatr 150(3):291–294

    Article  PubMed  Google Scholar 

  4. Drolet BA, Esterly NB, Frieden IJ (1999) “Hemangiomas in children,” Prim Care 173–181

  5. Cordisco MR (2009) “Hemangiomas of infancy: epidemiology”, Hemangiomas Vasc. Malformations An Atlas Diagnosis Treat 138:17–21

    Google Scholar 

  6. Blei F, Walter J, Orlow SJ, Marchuk DA (1998) Familial segregation of hemangiomas and vascular malformations as an autosomal dominant trait. Arch Dermatol 134(6):718–722

    Article  CAS  PubMed  Google Scholar 

  7. Frieden IJ et al (1997) Guidelines of care for hemangiomas of infancy. J Am Acad Dermatol 37(4):631–637

    Article  CAS  PubMed  Google Scholar 

  8. Krowchuk DP et al (2019) Clinical practice guideline for the management of infantile hemangiomas. Pediatr 143(1):1–28

    Article  Google Scholar 

  9. Hand JL, Frieden IJ (2002) Vascular birthmarks of infancy: resolving nosologic confusion. Am J Med Genet 108(4):257–264

    Article  PubMed  Google Scholar 

  10. Léauté-Labrèze C, Harper JI, Hoeger PH (2017) Infantile haemangioma. Lancet 390(10089):85–94

    Article  PubMed  Google Scholar 

  11. Colonna V, Resta L, Napoli A, Bonifazi E (2010) Placental hypoxia and neonatal haemangioma: clinical and histological observations. Br J Dermatol 162(1):208–209

    Article  CAS  PubMed  Google Scholar 

  12. de Jong S, Itinteang T, Withers AHJ, Davis PF, Tan ST (2016) Does hypoxia play a role in infantile hemangioma? Arch Dermatol Res 308(4):219–227

    Article  PubMed  Google Scholar 

  13. Leon-Villapalos J, Wolfe K, Kangesu L (2005) GLUT-1: An extra diagnostic tool to differentiate between haemangiomas and vascular malformations. Br J Plast Surg 58(3):348–352

    Article  CAS  PubMed  Google Scholar 

  14. Chang LC et al (2008) Growth characteristics of infantile hemangiomas: implications for management. Pediatrics 122(2):360–367

    Article  PubMed  Google Scholar 

  15. Tollefson MM, Frieden IJ (2012) “Early growth of infantile hemangiomas: what parents’photographs tell us,” Pediatr 130(2)

  16. Bauland CG, Lüning TH, Smit JM, Zeebregts CJ, Spauwen PHM (2011) Untreated hemangiomas: growth pattern and residual lesions. Plast Reconstr Surg 127(4):1643–1648

    Article  CAS  PubMed  Google Scholar 

  17. Couto RA, MacLellan RA, Zurakowski D, Greene AK (2012) Infantile hemangioma: clinical assessment of the involuting phase and implications for management. Plast Reconstr Surg 130(3):619–624

    Article  CAS  PubMed  Google Scholar 

  18. Baselga E et al (2016) Risk factors for degree and type of sequelae after involutionof untreated hemangiomas of infancy. JAMA Dermatol 152(11):1239–1243

    Article  PubMed  Google Scholar 

  19. Sánchez-Carpintero I, Ruiz-Rodriguez R, López-Gutiérrez JC (2011) Propranolol in the treatment of infantile hemangioma: clinical effectiveness, risks, and recommendations. Actas Dermosifiliogr 102(10):766–779

    Article  PubMed  Google Scholar 

  20. Drolet B (2015) Initiation and use of propranolol for infantile hemangioma : report of a consensus conference abstract

  21. Bauman NM et al (2014) Propranolol vs prednisolone for symptomatic proliferating infantile hemangiomas: a randomized clinical trial. JAMA Otolaryngol - Head Neck Surg 140(4):323–330

    Article  PubMed  Google Scholar 

  22. Ahogo CK et al (2013) Factors associated with the relapse of infantile haemangiomas in children treated with oral propranolol. Br J Dermatol 169(6):1252–1256

    Article  CAS  PubMed  Google Scholar 

  23. Chamlin SL et al (2007) “Multicenter prospective study of ulcerated hemangiomas,” J Pediatr 151(6)

  24. Martin JM, Sanchez S, González V, Cordero P, Ramon D (2019) Infantile hemangiomas with minimal or arrested growth: a retrospective case series. Pediatr Dermatol 36(1):125–131

    Article  PubMed  Google Scholar 

  25. Ma EH, Robertson SJ, Chow CW, Bekhor PS (2017) Infantile hemangioma with minimal or arrested growth: further observations on clinical and histopathologic findings of this unique but underrecognized entity. Pediatr Dermatol 34(1):64–71

    Article  PubMed  Google Scholar 

  26. Rotter A et al (2017) Ultrasonography as an objective tool for assessment of infantile hemangioma treatment with propranolol. Int J Dermatol 56(2):190–194

    Article  CAS  PubMed  Google Scholar 

  27. Menapace D, Mitkov M, Towbin R, Hogeling M (2016) The changing face of complicated infantile hemangioma treatment. Pediatr Radiol 46(11):1494–1506

    Article  PubMed  Google Scholar 

  28. Garzon MC et al (2016) PHACE syndrome: consensus-derived diagnosis and care recommendations. J Pediatr 178:24–33.e2

    Article  PubMed  PubMed Central  Google Scholar 

  29. Iacobas I et al (2010) LUMBAR: Association between cutaneous infantile hemangiomas of the lower body and regional congenital anomalies. J Pediatr 157(5):795–801.e7

    Article  PubMed  Google Scholar 

  30. Hoeger PH et al (2015) Treatment of infantile haemangiomas: recommendations of a European expert group. Eur J Pediatr 174(7):855–865

    Article  CAS  PubMed  Google Scholar 

  31. Léauté-Labrèze C et al (2015) A randomized, controlled trial of oral propranolol in infantile hemangioma. N Engl J Med 372(8):735–746

    Article  PubMed  Google Scholar 

  32. Shah SD et al (2016) “Rebound growth of infantile hemangiomas after propranolol therapy,” Pediatr 137(4)

  33. Caussé S et al (2013) Propranolol-resistant infantile haemangiomas. Br J Dermatol 169(1):125–129

    Article  PubMed  Google Scholar 

  34. Wedgeworth E et al (2016) Propranolol in the treatment of infantile haemangiomas: lessons from the European Propranolol in the Treatment of Complicated Haemangiomas (PITCH) Taskforce survey. Br J Dermatol 174(3):594–601

    Article  CAS  PubMed  Google Scholar 

  35. Chang L et al (2017) “When to stop propranolol for infantile hemangioma,” Sci Rep 7:1–7

  36. Thai T, Wang CY, Chang CY, Brown JD (2019) “Central nervous system effects of oral propranolol for infantile hemangioma: a systematic review and meta-analysis,” J Clin Med 8(2) 

  37. Prey S et al (2016) Safety of propranolol therapy for severe infantile hemangioma. JAMA - J Am Med Assoc 315(4):413–415

    Article  CAS  Google Scholar 

  38. Li X, Yang K, Li H, Huo R (2019) Propranolol treatment for infantile hemangiomas: short-term adverse effects and follow-up to age two. Biomed Res Int 2016:2019

    Google Scholar 

  39. Metry DW, Hebert AA (2000) Benign cutaneous vascular tumors of infancy: when to worry, what to do. Arch Dermatol 136(7):905–914

    Article  CAS  PubMed  Google Scholar 

  40. Boos MD, Castelo-Soccio L (2016) Experience with topical timolol maleate for the treatment of ulcerated infantile hemangiomas (IH). J Am Acad Dermatol 74(3):567–570

    Article  PubMed  Google Scholar 

  41. Mannschreck DB, Huang AH, Lie E, Psoter K, Puttgen K (2019) Topical timolol as adjunct therapy to shorten oral propranolol therapy for infantile hemangiomas. Pediatr Dermatol 36(3):283–289

    Article  PubMed  Google Scholar 

  42. Mcheik JN, Renauld V, Duport G, Vergnes P, Levard G (2005) Surgical treatment of haemangioma in infants. Br J Plast Surg 58(8):1067–1072

    Article  PubMed  Google Scholar 

  43. Chinnadurai S, Sathe NA, Surawicz T (2016) Laser treatment of infantile hemangioma: a systematic review. Lasers Surg Med 48(3):221–233

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Pediatrics Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Porto, Portugal

    Rita Gomes, Luís Salazar, Carolina Fraga, Alexandre Fernandes & Margarida Paiva Coelho

  2. Pediatric Surgery Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Porto, Portugal

    Mário Rui Correia & José Banquart Leitão

  3. Pediatric Surgery Department, Centro Hospitalar Universitário São João, Porto, Portugal

    Joana Barbosa-Sequeira

  4. Pediatric Cardiology Department, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Unit for Multidisciplinary Research in Biomedicine (UMIB), School of Medicine and Biomedical Sciences (ICBAS), Centro Materno Infantil Do Norte Albino Aroso, Porto, Portugal

    Sílvia Álvares

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  1. Rita Gomes
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  2. Luís Salazar
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  3. Carolina Fraga
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Contributions

All authors contributed to the study conception and design. Data collection was performed by Rita Gomes, Luís Salazar, Carolina Fraga, Mário Rui Correia, and Joana Barbosa-Sequeira. Data analysis was performed by Rita Gomes and Luís Salazar. The first draft of the manuscript was written by Rita Gomes and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rita Gomes.

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Ethics approval

This research complies with all the relevant national regulations and institutional policies and is in accordance to the tenets of the Helsinki Declaration. The study was approved by the Ethics Committee of Centro Hospitalar Universitário do Porto and Institute of Biomedical Sciences Abel Salazar.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Peter de Winter.

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Gomes, R., Salazar, L., Fraga, C. et al. Management of infantile hemangiomas—experience of a tertiary hospital. Eur J Pediatr 182, 1611–1618 (2023). https://doi.org/10.1007/s00431-023-04827-2

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  • DOI: https://doi.org/10.1007/s00431-023-04827-2

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