AAP Releases First Infantile Hemangioma Guidelines

The American Academy of Pediatrics has released its first guidelines on the treatment of infantile hemangiomas (IHs).

“Knowledge about IHs has advanced dramatically in the past decade…” they wrote. “As a result, pediatric providers have an opportunity to improve care and reduce morbidity in infants with IHs by promptly recognizing which IHs are potentially high risk and when intervention is needed.”

They conducted a comparative effectiveness review of the potential benefits and harms of diagnostic modalities and pharmacologic and surgical treatment. Studies included in the search were published between 1982 and 2015, and an updated literature review for the period of July 2015 to January 2017 was also conducted.

The guidelines state that problematic hemangiomas, including those that may cause permanent scarring and disfigurement, hepatic or airway IHs, and IHs with the potential for functional impairment, ulceration, and associated underlying abnormalities, should be treated early.

Further, it recommends the use of propranolol at a dose of 2 to 3 mg/kg per day, with treatment typically being continued for at least 6 months and maintained until 12 months of age. Topical timolol may also be used for the treatment of certain superficial IHs.

“The CPG encourages enhanced communication between primary care clinicians and hemangioma specialists to ensure early assessment and treatment of infants in whom active intervention is indicated, to improve patient outcomes, and to enhance anticipatory guidance. It is not intended to be a sole source of guidance in the management of children with IHs, to replace clinical judgment, or to establish a protocol for all infants with IHs. Rather, it provides a framework for clinical decision-making.”

—Michael Potts

Reference:

Krowchuk DP, Frieden IJ, Mancini AJ, et al. Clinical practice guideline for the management of infantile hemangiomas. Pediatrics. 2019;143(1). doi: 10.1542/peds.2018-3475.