From the Guidelines
The approach to hemangiomas in newborn infants should prioritize careful observation and monitoring, with treatment indicated for hemangiomas that cause functional impairment, are in high-risk locations, are ulcerating, or causing significant disfigurement, using oral propranolol as the first-line medical treatment, as recommended by the most recent clinical practice guideline for the management of infantile hemangiomas 1.
Key Considerations
- Most infantile hemangiomas are small, innocuous, and self-resolving, requiring no treatment, but a significant minority may be potentially problematic due to their size or location 1.
- The most rapid and significant growth of hemangiomas occurs between 1 and 3 months of age, and growth is completed by 5 months of age in most cases, making early intervention and/or referral (ideally by 1 month of age) crucial for infants with potentially problematic hemangiomas 1.
- Propranolol is the drug of choice for systemic treatment, at a dose of 2 to 3 mg/kg per day, continued for at least 6 months and often maintained until 12 months of age (occasionally longer) 1.
Treatment Options
- Oral propranolol is the first-line medical treatment for hemangiomas that require intervention, with a recommended dose of 2 to 3 mg/kg per day 1.
- Topical timolol may be used to treat select small, thin, superficial hemangiomas 1.
- Surgery and/or laser treatment are most useful for the treatment of residual skin changes after involution and, less commonly, may be considered earlier to treat some hemangiomas 1.
Important Considerations
- Baseline cardiac evaluation is necessary before starting propranolol, and blood glucose monitoring is recommended during the initial dosing period 1.
- Systemic corticosteroids are now considered second-line therapy due to side effects, and propranolol is preferred due to its effectiveness and fewer side effects 1.
From the Research
Approach to Hemangioma in Newborn Infants
The approach to hemangioma in newborn infants involves understanding the natural history, clinical manifestations, diagnosis, and management of infantile hemangiomas.
- The majority of infantile hemangiomas are not present at birth, but appear in the first few weeks of life as areas of pallor, followed by telangiectatic or faint red patches 2.
- These lesions grow rapidly in the first 3 to 6 months of life, with superficial lesions being bright red and protuberant, and deep lesions being bluish and dome-shaped 2.
- Involution typically begins by the time the child is a year old, with approximately 50% of infantile hemangiomas showing complete involution by age 5,70% by age 7, and 95% by age 10 to 12 2.
Treatment Options
Treatment options for infantile hemangiomas include:
- Oral propranolol, which is currently the treatment of choice for high-risk and complicated infantile hemangiomas 2, 3, 4.
- Topical timolol, which may be considered for superficial infantile hemangiomas that need to be treated and for complicated infantile hemangiomas in patients at risk for severe adverse events from oral administration of propranolol 2.
- Other therapies, such as wound care, topical beta-blocker therapy, and treatment of IH residua, may also be used 5.
- Laser therapy and surgical excision are also available treatment options, although they are less commonly used 6.
Indications for Active Intervention
Indications for active intervention include:
- Hemorrhage unresponsive to treatment
- Impending ulceration in areas where serious complications might ensue
- Interference with vital structures
- Life- or function-threatening complications
- Significant disfigurement 2.