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Update August 2021

Blei, Francine
PMID: 34328787
ISSN: 1557-8585
CID: 4950062

How we approach hemangiomas in infants

Mayer, Jennifer L R; Intzes, Stefanos; Oza, Vikash S; Blei, Francine
Pediatric oncologists are increasingly involved in the management of benign vascular tumors and their associated life-threatening complications. Hemangiomas are the most common referring diagnosis to multidisciplinary vascular anomalies clinics. However, as contemporary research has revealed, hemangiomas are not a single, easily defined entity but rather a diverse set of related vascular tumors, each having a unique natural history, growth pattern, and response to therapy. This manuscript seeks to illustrate how we evaluate and manage these complex tumors, their complications, and associated syndromes, while remaining ever vigilant for malignant hemangioma mimickers such as soft tissue sarcomas and congenital leukemia.
PMID: 34151510
ISSN: 1545-5017
CID: 4918132

Update June 2021

Blei, Francine
PMID: 34137649
ISSN: 1557-8585
CID: 4917602

Clinical Features, Prognostic Factors, and Treatment Interventions for Ulceration in Patients With Infantile Hemangioma

Fernández Faith, Esteban; Shah, Sonal; Witman, Patricia M; Harfmann, Katya; Bradley, Flora; Blei, Francine; Pope, Elena; Alsumait, Anwar; Gupta, Deepti; Covelli, Isabela; Streicher, Jenna L; Cotton, Colleen; Tollefson, Megha; Nguyen, Henry; Hunt, Raegan; Moore-Clingenpeel, Melissa; Frieden, Ilona J
Importance/UNASSIGNED:Ulceration is a common complication of infantile hemangioma (IH), which leads to substantial morbidity. Ulceration in IH has not been systematically studied since the advent of β-blocker therapy for IH. Objectives/UNASSIGNED:To examine treatment interventions used for ulceration in IH and identify clinical prognostic indicators of healing time. Design, Setting, and Participants/UNASSIGNED:A retrospective, multicenter cohort study was conducted on 436 consecutive patients with a clinical diagnosis of ulcerated IH and available clinical photographs. Patients receiving care at tertiary referral centers evaluated between 2012 and 2016 were included; statistical and data analysis were performed from February 7 to April 27, 2020. Exposures/UNASSIGNED:Clinical characteristics, treatment interventions, course, complications, and resource use were analyzed. Treatment interventions for ulceration in IH included local (wound care, topical), systemic (β-blocker, corticosteroids), and procedural (pulsed-dye laser). Main Outcomes and Measures/UNASSIGNED:The primary end point was time to complete or nearly complete ulceration healing. Clinical characteristics were analyzed to determine the responses to most common interventions and prognostic factors for healing of ulceration. Results/UNASSIGNED:Of the 436 patients included in the study, 327 were girls (75.0%); median age at ulceration was 13.7 weeks (interquartile range, 8.86-21.30 weeks). The median heal time was 4.79 weeks (95% CI, 3.71-5.86 weeks) with wound care alone, 5.14 weeks (95% CI, 4.57-6.00 weeks) with timolol, 6.36 weeks (95% CI, 5.57-8.00 weeks) with a systemic β-blocker, and 7.71 weeks (95% CI, 6.71-10.14 weeks) with multimodal therapy. After adjusting for IH size, a dose of propranolol less than or equal to 1 mg/kg/d was associated with shorter healing time compared with higher propranolol doses (hazard ratio, 2.04; 95% CI, 1.11 to 3.73; P = .02). Size of the IH was identified as a significant prognostic factor for healing time in multivariable analysis. Increasing size of IH portends a proportionately longer time to heal of the ulceration. Conclusions and Relevance/UNASSIGNED:Despite the use of β-blockers, this cohort study found that a subset of patients with IH ulceration continued to experience prolonged IH healing times. Larger IH size appears to be a poor prognostic factor for time to heal. For patients requiring systemic therapy, initiation of propranolol at lower doses (≤1 mg/kg/d) should be considered.
PMID: 33787840
ISSN: 2168-6084
CID: 4830842

Update April 2021

Blei, Francine
PMID: 33900826
ISSN: 1557-8585
CID: 4853042

Update February 2021

Blei, Francine
PMID: 33625887
ISSN: 1557-8585
CID: 4794722

Update December 2020

Blei, Francine
PMID: 33351734
ISSN: 1557-8585
CID: 4726482

Update October 2020

Blei, Francine
PMID: 33107756
ISSN: 1557-8585
CID: 4646502

Update August 2020

Blei, Francine
PMID: 32780620
ISSN: 1557-8585
CID: 4556262

Update June 2020

Blei, Francine
PMID: 32503381
ISSN: 1557-8585
CID: 4477562