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

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