Published online August 1, 2008
PEDIATRICS Vol. 122 No. 2 August 2008, pp. 360-367 (doi:10.1542/peds.2007-2767)

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ARTICLE

Growth Characteristics of Infantile Hemangiomas: Implications for Management

Linda C. Chang, MD^a, Anita N. Haggstrom, MD^b, Beth A. Drolet, MD^c, Eulalia Baselga, MD^d, Sarah L. Chamlin, MD^e, Maria C. Garzon, MD^f, Kimberly A. Horii, MD^g, Anne W. Lucky, MD^h, Anthony J. Mancini, MD^e, Denise W. Metry, MDⁱ, Amy J. Nopper, MD^g, Ilona J. Frieden, MD^a for the Hemangioma Investigator Group

^a Department of Dermatology, University of California, San Francisco, California
^b Departments of Dermatology and Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
^c Department of Dermatology, Medical College of Wisconsin, Milwaukee, Wisconsin
^d Department of Dermatology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
^e Departments of Pediatrics and Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
^f Departments of Dermatology and Pediatrics, Columbia University, New York, New York
^g Section of Dermatology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri
^h Division of Pediatric Dermatology and the Hemangioma and Vascular Malformation Center, Cincinnati Children's Hospital, Cincinnati, Ohio
ⁱ Departments of Dermatology and Pediatrics, Baylor College of Medicine, Houston, Texas

OBJECTIVES. Infantile hemangiomas often are inapparent at birth and have a period of rapid growth during early infancy followed by gradual involution. More precise information on growth could help predict short-term outcomes and make decisions about when referral or intervention, if needed, should be initiated. The objective of this study was to describe growth characteristics of infantile hemangioma and compare growth with infantile hemangioma referral patterns.

METHODS. A prospective cohort study involving 7 tertiary care pediatric dermatology practices was conducted. Growth data were available for a subset of 526 infantile hemangiomas in 433 patients from a cohort study of 1096 children. Inclusion criteria were age younger than 18 months at time of enrollment and presence of at least 1 infantile hemangioma. Growth stage and rate were compared with clinical characteristics and timing of referrals.

RESULTS. Eighty percent of hemangioma size was reached during the early proliferative stage at a mean age of 3 months. Differences in growth between hemangioma subtypes included that deep hemangiomas tend to grow later and longer than superficial hemangiomas and that segmental hemangiomas tended to exhibit more continued growth after 3 months of age. The mean age of first visit was 5 months. Factors that predicted need for follow-up included ongoing proliferation, larger size, deep component, and segmental and indeterminate morphologic subtypes.

CONCLUSIONS. Most infantile hemangioma growth occurs before 5 months, yet 5 months was also the mean age at first visit to a specialist. Recognition of growth characteristics and factors that predict the need for follow-up could help aid in clinical decision-making. The first few weeks to months of life are a critical time in hemangioma growth. Infants with hemangiomas need close observation during this period, and those who need specialty care should be referred and seen as early as possible within this critical growth period.

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Key Words: hemangioma/therapy • hemangioma/complications • hemangioma/growth • infant-newborn • infant • hemangioma/prognosis • skin neoplasms/growth

Abbreviations: IH—infantile hemangioma

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Accepted Nov 29, 2007.

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