PMID- 36705724 OWN - NLM STAT- MEDLINE DCOM- 20230510 LR - 20230510 IS - 1432-1076 (Electronic) IS - 0340-6199 (Linking) VI - 182 IP - 4 DP - 2023 Apr TI - Management of infantile hemangiomas-experience of a tertiary hospital. PG - 1611-1618 LID - 10.1007/s00431-023-04827-2 [doi] AB - The purpose of the study is to describe the experience of a multidisciplinary team in a tertiary hospital regarding the management of Infantile Hemangiomas (IH). The method employed is a retrospective analysis of patients with IH followed in a tertiary pediatric hospital between January 2010 and May 2022. A total of 393 IH were diagnosed (56.7% female), with a median age of 5 months (interquartile range (IQR), 3-10). Imaging investigation was necessary for diagnosis and for exclusion of other IH in 9.2% and 14.3%, respectively. Focal (74.0%) and superficial (59.7%) lesions were more frequent as was facial location (35.9%). Pre-treatment ulceration or hemorrhage occurred in 6.6%. At follow-up, 87.4% regressed partially and 12.6% completely; 2.7% relapsed. Propranolol was started in 30.0% of cases for a median period of 9 months (IQR, 6-12), mainly due to esthetic concerns (41.9%). Side effects occurred in 8.3% (sleep disturbance in 5.1%). Only 1.7% were refractory and 5.9% had a rebound effect. Eleven patients were treated with topical timolol and 41 underwent surgery. Patients that were treated with propranolol had more risk factors (p = 0.016) and presented deeper lesions (p < 0.001) with a larger diameter (p < 0.001); total IH regression was less frequent (p < 0.001). Since 2020, twice-daily dosage was more frequently prescribed than three times daily (p = 0.007) and inpatient initiation of propranolol decreased (p = 0.750), without significant difference in the incidence of adverse reactions, duration of treatment, and lesion evolution. Conclusions: Our protocol proved to be safe and feasible in an outpatient setting and twice daily administration of propranolol was effective. The majority of IH showed at least partial regression. Early detection of high-risk IH is paramount and a multidisciplinary assessment by a specialized team is essential for adequate management. What is Known: * IH are the most common vascular tumors in childhood. Although the majority evolves favorably, treatment may be warranted in selected cases. * Early detection of high-risk IH is paramount, and a multidisciplinary assessment by a specialized team is essential for adequate management. What is New: * One-third of our sample was treated with propranolol. These patients had more risk factors and presented deeper lesions with a larger diameter, and tumor total regression was less frequent. * Our results reinforce safety and feasibility of propranolol initiation in an outpatient setting, including twice daily dosage. CI - (c) 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature. FAU - Gomes, Rita AU - Gomes R AUID- ORCID: 0000-0003-1246-194X AD - Pediatrics Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitario Do Porto (CMIN-CHUPorto), Porto, Portugal. ritagomesmoreira02@gmail.com. FAU - Salazar, Luis AU - Salazar L AUID- ORCID: 0000-0002-3760-5121 AD - Pediatrics Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitario Do Porto (CMIN-CHUPorto), Porto, Portugal. FAU - Fraga, Carolina AU - Fraga C AUID- ORCID: 0000-0002-9782-3999 AD - Pediatrics Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitario Do Porto (CMIN-CHUPorto), Porto, Portugal. FAU - Correia, Mario Rui AU - Correia MR AUID- ORCID: 0000-0002-0999-6524 AD - Pediatric Surgery Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitario Do Porto (CMIN-CHUPorto), Porto, Portugal. FAU - Barbosa-Sequeira, Joana AU - Barbosa-Sequeira J AUID- ORCID: 0000-0002-2776-7055 AD - Pediatric Surgery Department, Centro Hospitalar Universitario Sao Joao, Porto, Portugal. FAU - Fernandes, Alexandre AU - Fernandes A AD - Pediatrics Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitario Do Porto (CMIN-CHUPorto), Porto, Portugal. FAU - Alvares, Silvia AU - Alvares S AUID- ORCID: 0000-0002-2222-5943 AD - Pediatric Cardiology Department, Centro Hospitalar Universitario Do Porto (CMIN-CHUPorto), Unit for Multidisciplinary Research in Biomedicine (UMIB), School of Medicine and Biomedical Sciences (ICBAS), Centro Materno Infantil Do Norte Albino Aroso, Porto, Portugal. FAU - Banquart Leitao, Jose AU - Banquart Leitao J AD - Pediatric Surgery Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitario Do Porto (CMIN-CHUPorto), Porto, Portugal. FAU - Paiva Coelho, Margarida AU - Paiva Coelho M AD - Pediatrics Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitario Do Porto (CMIN-CHUPorto), Porto, Portugal. LA - eng PT - Journal Article DEP - 20230127 PL - Germany TA - Eur J Pediatr JT - European journal of pediatrics JID - 7603873 RN - 9Y8NXQ24VQ (Propranolol) RN - 0 (Adrenergic beta-Antagonists) SB - IM MH - Humans MH - Female MH - Child MH - Infant MH - Male MH - Propranolol/therapeutic use MH - *Hemangioma/diagnosis/drug therapy MH - Retrospective Studies MH - Tertiary Care Centers MH - Treatment Outcome MH - Administration, Oral MH - *Skin Neoplasms/diagnosis/drug therapy MH - Adrenergic beta-Antagonists/therapeutic use OTO - NOTNLM OT - Children OT - Hemangioma OT - Neoplasms OT - Propranolol OT - Vascular tissue EDAT- 2023/01/28 06:00 MHDA- 2023/05/10 06:42 CRDT- 2023/01/27 11:14 PHST- 2022/11/20 00:00 [received] PHST- 2023/01/15 00:00 [accepted] PHST- 2023/01/07 00:00 [revised] PHST- 2023/05/10 06:42 [medline] PHST- 2023/01/28 06:00 [pubmed] PHST- 2023/01/27 11:14 [entrez] AID - 10.1007/s00431-023-04827-2 [pii] AID - 10.1007/s00431-023-04827-2 [doi] PST - ppublish SO - Eur J Pediatr. 2023 Apr;182(4):1611-1618. doi: 10.1007/s00431-023-04827-2. Epub 2023 Jan 27.