About Infantile Hemangioma

Infantile hemangiomas are benign vascular tumors characterized by the proliferation of the endothelial cells.1 These lesions are rarely present at birth, but appear within the first few weeks of a child’s life.2

The evolution phases of infantile hemangioma growth include3-5:

The proliferation phase: rapid growth between 5 ½ and 7 ½ weeks of age that can last up to 6 months or longer3,4

The involution phase: stabilization then a slow, spontaneous regression over a span of 3 to 9 years5

INFANTILE HEMANGIOMA GROWTH PATTERN

The Cause of Infantile Hemangioma

It is not well understood what causes infantile hemangiomas. However, studies indicate that fetal hypoxic stress might trigger proliferation and abnormal blood vessel formation by stimulating endothelial progenitor cells.

Another hypothesis is that immature endothelial cells and pericytes, which coexist in the late stages of fetal development, may maintain persistent proliferation properties for a period of time after birth, leading to the development of infantile hemangioma.2

Population at Risk

Diagnosis and Treatment

The first step in determining a diagnosis of infantile hemangioma is to perform a physical examination and discuss the infant’s medical history with their parent or caregiver. You will particularly want to know how long the infantile hemangioma has been present and if it has changed.7

Although you will often be able to diagnose infantile hemangiomas based on physical examination and medical history, imaging tests can also be helpful.7

You can use magnetic resonance imaging (MRI) to help differentiate infantile hemangiomas from other vascular lesions, such as arteriovenous or venous malformations. A skin biopsy can also be helpful in distinguishing unusual or atypical hemangiomas from other vascular lesions.8 GLUT-1 is an exclusive marker for infantile hemangioma and is used to distinguish infantile hemangiomas from other vascular lesions. Using glucose transporter 1 (GLUT-1) stain is helpful in evaluating tissue removed during a biopsy or excision. Proliferating and involuting infantile hemangiomas stain positively for GLUT-1, while other cutaneous vascular neoplasms, malformations, and normal cutaneous vasculature do not, making this stain very sensitive and specific for histologic confirmation of infantile hemangiomas.9

It may be important to refer to a specialist, such as a pediatric dermatologist, to help confirm a diagnosis and find the most appropriate treatment for your patient as soon as possible.2 Early treatment during the proliferation phase between 1 month to 5 months is important.3

Early Therapeutic Intervention During the Proliferation Phase of Hemangioma Growth Is Essential

Click here to learn more about the different types of infantile hemangiomas.



INDICATION
HEMANGEOLTM oral solution contains the beta-adrenergic blocker propranolol hydrochloride and is indicated for the treatment of proliferating infantile hemangioma requiring systemic therapy.

IMPORTANT SAFETY INFORMATION
HEMANGEOLTM is contraindicated in the following conditions:
  • Premature infants with corrected age <5 weeks
  • Infants weighing less than 2 kg
  • Known hypersensitivity to propranolol or any of the excipients
  • Asthma or history of bronchospasm
  • Heart rate <80 beats per minute, greater than first degree heart block, or decompensated heart failure
  • Blood pressure < 50/30 mmHg
  • Pheochromocytoma
HEMANGEOLTM prevents the response of endogenous catecholamines to correct hypoglycemia and masks the adrenergic warning signs of hypoglycemia, particularly tachycardia, palpitations and sweating.

HEMANGEOLTM can cause hypoglycemia in children, especially when they are not feeding regularly or are vomiting; withhold the dose under these conditions. Hypoglycemia may present in the form of seizures, lethargy, or coma. If a child has clinical signs of hypoglycemia, parents should discontinue HEMANGEOLTM and call their health care provider immediately or take the child to the emergency room.

Concomitant treatment with corticosteroids may increase the risks of hypoglycemia.

HEMANGEOLTM may cause or worsen bradycardia or hypotension. Monitor heart rate and blood pressure after treatment initiation or increase in dose. Discontinue treatment if severe (<80 beats per minute) or symptomatic bradycardia or hypotension (systolic blood pressure <50 mmHg) occurs.

HEMANGEOLTM can cause bronchospasm; do not use in patients with asthma or a history of bronchospasm. Interrupt treatment in the event of a lower respiratory tract infection associated with dyspnea and wheezing.

HEMANGEOLTM may worsen circulatory function in patients with congestive heart failure or increase the risk of stroke in PHACE syndrome patients with severe cerebrovascular anomalies. Investigate infants with large facial infantile hemangioma for potential arteriopathy associated with PHACE syndrome prior to HEMANGEOLTM therapy.

HEMANGEOLTM will interfere with epinephrine used to treat serious anaphylaxis.

The most frequently reported adverse reactions to HEMANGEOLTM (occurring ≥10% of patients) were sleep disorders, aggravated respiratory tract infections, diarrhea, and vomiting. Adverse reactions led to treatment discontinuation in fewer than 2% of treated patients.

The most common ( >3% more often on HEMANGEOLTM than on placebo) adverse reactions reported in the a total of 424 patients treated with HEMANGEOLTM 1.2 mg/kg/day or 3.4 mg/kg/day were sleep disorder (17.5%; 16.1%), bronchitis (8%; 13.4%), peripheral coldness (8%; 6.7%), agitation (8.5%; 4.5%), diarrhea (4.5%; 6.3%), somnolence (5%; 0.9%), nightmare (2%; 6.3%), irritability (5.5%; 1.3%), decreased appetite (2.5%; 3.6%), and abdominal pain (3.5%; 0.4%), respectively.

Adverse events such as cardiac disorders, urticaria, alopecia, hypogylcemia, and bradycardia occurred in less than 1%.

Safety and effectiveness for infantile hemangioma have not been established in pediatric patients greater than 1 year of age.

Please see Full Prescribing Information and Medication Guide .

Important Safety Information
References