Infantile Hemangioma Guidelines

Updated: Nov 09, 2020
  • Author: Richard J Antaya, MD; Chief Editor: William D James, MD  more...
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Guidelines Summary

Guidelines on the management of infantile hemangioma were released in December 2018 by the American Academy of Pediatrics. [77, 78]

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

  • Life-threatening lesions, such as those that obstruct the airway, those that are associated with high-output congestive heart failure, or those that are ulcerative and profusely bleed
  • Infantile hemangiomas associated with functional impairment, such as a disturbance in vision or feeding interference
  • Infantile hemangioma ulceration
  • Infantile hemangioma–associated congenital anomalies such as PHACE (posterior fossa abnormalities, hemangioma, arterial lesions, cardiac abnormalities/aortic coarctation, and eye abnormalities) syndrome
  • Risk of permanent scarring

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

Infantile hemangioma growth occurs most rapidly from age 1-3 months.

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

Oral propranolol (2-3 mg/kg/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 infantile hemangiomas in certain critical locations (eg, the lip) or during proliferation.

Topical timolol maleate may be prescribed for thin or superficial infantile hemangiomas.

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 infantile hemangioma, the natural history of tumors, and the potential for complications or scarring.