From the Guidelines
The management of congenital hemangiomas in newborns primarily involves careful observation and monitoring, as many lesions will involute spontaneously without treatment. Initial evaluation should include a thorough physical examination to distinguish between rapidly involuting congenital hemangiomas (RICH), which typically regress within the first year of life, and non-involuting congenital hemangiomas (NICH), which persist. For asymptomatic lesions without complications, watchful waiting is recommended with regular follow-up visits to monitor changes. If the hemangioma causes complications such as ulceration, bleeding, functional impairment, or significant disfigurement, intervention may be necessary.
Key Considerations
- First-line pharmacological treatment is oral propranolol at 2-3 mg/kg/day divided into three doses, initiated in a monitored setting with gradual dose escalation over 1-2 weeks, as supported by the British Society for Paediatric Dermatology consensus guidelines 1.
- Treatment typically continues for 6-12 months with regular monitoring of heart rate, blood pressure, and blood glucose.
- For smaller or superficial lesions, topical timolol 0.5% gel applied twice daily may be effective.
- Surgical excision is reserved for hemangiomas that fail to respond to medical therapy, cause significant functional impairment, or for NICH lesions that won't involute spontaneously.
- Laser therapy may be considered for residual telangiectasias after involution.
- Parents should be educated about the natural history of these lesions, potential complications to watch for, and the importance of regular follow-up appointments, as emphasized by the clinical practice guideline for the management of infantile hemangiomas 1.
Monitoring and Follow-Up
- Regular follow-up visits are crucial to monitor changes in the hemangioma and to identify potential complications early.
- The American Academy of Pediatrics (AAP) recommends early and frequent monitoring in the first few weeks and months of life to identify those hemangiomas that require intervention 1.
From the Research
Approach to Congenital Hemangioma in Newborn Infants
- Congenital hemangiomas are fully formed at birth and differ from infantile hemangiomas in their histological and immunohistochemical findings 2.
- They are characterized as either rapidly involuting congenital hemangiomas (RICHs) or noninvoluting congenital hemangiomas (NICHs) based on their clinical progression 3.
- RICHs may ulcerate or bleed early in their presentation, but involute quickly during the first few months of life, while NICHs are persistent and have no associated complications 3.
Treatment Options
- The majority of infantile hemangiomas require no treatment, but indications for active intervention include hemorrhage, impending ulceration, interference with vital structures, and significant disfigurement 4.
- Treatment options include oral propranolol, topical timolol, and oral corticosteroids, with oral propranolol being the treatment of choice for high-risk and complicated infantile hemangiomas 4, 5.
- Propranolol has been shown to be effective in reducing the need for surgery in the management of infantile hemangioma 6.
Management of Congenital Hemangiomas
- Congenital intracranial hemangiomas are rare benign vascular tumors that develop before birth, and early postnatal oral propranolol treatment has been reported to be safe and effective 5.
- The clinical characteristics and management of congenital hemangiomas are distinct from those of infantile hemangiomas, and treatment should be individualized based on the size, location, and complications of the lesion 2, 3.