Management of Infantile Hemangiomas
Publication Date: January 1, 2019
Last Updated: March 14, 2022
Recommendations
Risk Stratification, Triage, and Referral
Classify an IH as high risk if there is evidence of or potential for the following: (1) life-threatening complications, (2) functional impairment or ulceration, (3) structural anomalies (eg, in PHACE syndrome or LUMBAR syndrome), or (4) permanent disfigurement. (XStrong)
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After identifying an IH as high risk, facilitate evaluation by a hemangioma specialist as soon possible. (XStrong)
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Imaging
Do not perform imaging unless the diagnosis of IH is uncertain, there are ≥5 cutaneous IHs, or associated anatomic abnormalities are suspected. (BModerate)
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Perform ultrasonography as the initial imaging modality when the diagnosis of IH is uncertain. (CWeak)
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Perform MRI when concerned about associated structural abnormalities (eg, PHACE syndrome or LUMBAR syndrome). (BWeak)
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Pharmacotherapy
Use oral propranolol as the first-line agent for IHs requiring systemic treatment. (A, Strong)
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Dose propranolol between 2 and 3 mg/kg per d unless there are comorbidities (eg, PHACE syndrome) or adverse effects (eg, sleep disturbance) that necessitate a lower dose. (AModerate)
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Counsel that propranolol be administered with or after feeding and that doses be held at times of diminished oral intake or vomiting to reduce the risk of hypoglycemia. (XStrong)
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Evaluate patients for and educate caregivers about potential adverse effects of propranolol, including sleep disturbances, bronchial irritation, and clinically symptomatic bradycardia and hypotension. (XStrong)
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May prescribe oral prednisolone or prednisone to treat IHs if there are contraindications or an inadequate response to oral propranolol. (BModerate)
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May recommend intralesional injection of triamcinolone and/or betamethasone to treat focal, bulky IHs during proliferation or in certain critical anatomic locations (eg, the lip). (BModerate)
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May prescribe topical timolol maleate as a therapy for thin and/or superficial IHs. (BModerate)
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Surgical management
May recommend surgery and laser therapy as treatment options in managing selected IHs. (C, Moderate)
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Parent education
Educate caregivers of infants with an IH about the condition, including the expected natural history and its potential for causing complications or disfigurement. (XStrong)
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Recommendation Grading
Disclaimer
Overview
Title
Management of Infantile Hemangiomas
Authoring Organization
American Academy of Pediatrics
Publication Month/Year
January 1, 2019
Last Updated Month/Year
June 12, 2023
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Child, Infant
Health Care Settings
Ambulatory, Emergency care, Hospital, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Assessment and screening, Diagnosis, Management, Treatment
Keywords
Infantile hemangiomas (IHs), benign tumor pediatric, hemangioma, hepatic hemangioma (IHS), airway hemangioma (IHS), Organ IHS, ulceration, PHACE, Lumbar syndrome
Source Citation
Daniel P. Krowchuk, et al. Clinical Practice Guidelines for the Management of Infantile Hemangiomas. Pediatrics. 2019; 143(1): e20183475.
Methodology
Number of Source Documents
164
Literature Search Start Date
June 1, 2015
Literature Search End Date
January 1, 2017