Management of Infantile Hemangiomas Clinical Practice Guidelines (2019)

American Academy of Pediatrics

Reviewed and summarized by Medscape editors

February 06, 2019

The guidelines on the management of infantile hemangioma were released on December 24, 2018, by the AAP.[1,2]

Five indications for early treatment of problematic infantile hemangiomas (IHs) include the following:

  1. Life-threatening lesions, such as those that obstruct the airway, are associated with high-output congestive heart failure or ulcerative IHs that profusely bleed.

  2. IHs associated with functional impairment such as disturbance in vision or feeding interference.

  3. IH ulceration.

  4. IH-associated congenital anomalies such as PHACE syndrome (large IHs that can cause defects in the eyes, heart, major arteries, and brain).

  5. Risk of permanent scarring.

Consult with a hemangioma specialist by 1 month of age for infants that are high-risk.

IH growth most rapidly occurs between 1 and 3 months of age.

Imaging is not necessary unless the diagnosis is uncertain, there are five or more cutaneous IHs, or there is suspicion of anatomic abnormalities.

Oral propranolol (between 2 and 3 mg/kg per dose) is the recommended first-line treatment for cases requiring systemic therapy.

Counsel about the adverse events of propranolol such as sleep disturbances, bronchial irritation, and clinically symptomatic bradycardia and hypotension.

Use oral prednisolone or prednisone if there are contraindications or if the propranolol response is inadequate.

Intralesional injection of triamcinolone and/or betamethasone can be recommended to treat focal or bulky IHs in certain critical locations (eg, the lip) or during proliferation.

Topical timolol maleate may be prescribed for thin or superficial IHs.

Surgery and laser therapy may be recommended for certain situations such as ulcerated lesions or lesions that obstruct vital structures.

Caregivers should be educated about IH, the natural history of tumors and potential for complications or scarring.

For more Clinical Practice Guidelines, please go to Guidelines.

For more information, go to Infantile Hemangioma.

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