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THE BULGARIAN EXPERIENCE IN TREATING HEMANGIOMA WITH PROPRANOLOL IN
CHILDREN
Maslarska R.
MD, Pediatrician, Neonatologist, Head of Department of Neonatology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria DOI: 10.5281/zenodo.7479741
ABSTRACT
Hemangioma in children is a frequently encountered benign tumor originating from the endothelial cells. The Bulgarian experience in treating hemangioma with propranolol (Hemangiol) in children is presented in this research. 276 children with hemangioma in different locations were included in the survey, and they were analyzed based on the following criteria: sex, delivery mechanism, age at the beginning of propranolol treatment, localization and type of the hemangioma; method, duration and result of the Hemangiol treatment. The results show recovery in 83.7% of the cases.
Keywords: Hemangioma, Hemangiol treatment, children.
Introduction:
Hemangioma in children is a frequently encountered benign tumor originating from the endothelial cells [1]. The process of fully healing the lesion may take years. Hemangioma can be encountered relatively frequently - in 8-12% of all newborns and in 22% of preterm children, whereby they are more frequent in girls (women:men = 3:1) [1,2]. These skin cutaneous changes are one of the most frequent reasons for a consultation by dermatologists, pediatricians, or neonatal specialists in the first moths after the delivery.
Most hemangiomas in newborns are of little clinical importance, and are simply and aesthetic issue. In a significant percentage of children, however, hemangio-mas are associated with complications in the period after the birth and in early childhood and cause significant morbidity [1]. This necessitates that both pediatricians and neonatologists, as well as consulting dermatologists have in-depth knowledge of the issue. Timely diagnostics, full laboratory tests and imaging and adequate treatment are of particular importance in preventing complications from the condition. With the
introduction of oral propranolol many of the conventional treatment options have gone out of use.
Methodology: The goal of this research is to present the Bulgarian experience in treating hemangioma with propranolol (Hemangiol) in children.
The following tasks were specified in order to realise this goal:
1. A clinical characteristic of the patients treated with Hemangiol.
2. Tracking those patients.
3. Analysis and assessment of the Hemangiol treatment's success rate.
4. Formulating recommendations and procedure for patients requiring Hemangiol treatment.
The following statistics methods were used.
Descriptive statistics:
Quantitative variables were presented by summarizing statistics characteristics - mean, median, standard deviation (SD), minimal and maximal value.
Categorical variable are presented as absolute (N) and relative (%) frequencies.
The significance level is a=0,05. Statistical signif- Results and discussion:
icance is when the value of p is smaller than a (p<0.05). 276 children were included in the survey, which
The specialized Statistical Package for the Social Sci- was carried out in 2020. 85 of them were boys and 192 ences (SPSS) version 20.0 was used to process the data. were girls (Table 1).
Table 1.
Distribution of the sex
Sex Number %
Girls 84 30,4
Boys 192 69,6
Total 276 100,0
The delivery mechanism distribution in the children with hemangioma is presented in figure 1. It is notable that hemangioma occurred in 68,1% of the C-section deliveries
Figure 1. Delivery mechanism distribution in the children with hemangioma.
The age at which treatment began in the patients observed varies from 2 months to 1 year (Table 2). The biggest relative share - 44.9% - is of those who started treatment at 2-4 months of age, followed by patients whose treatment began at 4-6 months old (26,1%). Our
results correspond to the recommendations from the "Consensus of the Bulgarian Expert Group on Treating Hemangioma", where it is said that treatment should start in nursing children aged from 5 weeks to 5 months.
Table 2.
Age at the start of Propranolol__
Age at the start of treatment Number %
Up to 2 months 18 6,5
2-4 months 124 44,9
4-6 months 72 26,1
6 months - 1 year 52 18,8
Over 1 year 10 3,6
Total 276 100,0
We studied the localization, number and type of hemangiomas in the observed group of children. The most frequent location was the face in 44,2% of the patents included in the survey, followed by the body -22,5%, and a combined localization - 22,1%.
Table 3.
Hemangioma localization distribution
Localization Number %
Face 122 44,2
Body 62 22,5
Limbs 31 11,2
Combined 61 22,1
Total 276 100,0
Only one hemangioma is observed in 69,9% of the children included in the survey, while 15,8 % of the cases have two hemangiomas, and 8.3% have multiple hemangiomas. The hemangioma type is presented in Table 4. In the biggest relative share of the observed children - 49,3% - the hemangioma is superficial, 29,7 % it is deep and in 20,7% it is mixed. The hemangioma type is of crucial importance to the treatment method and patient monitoring.
Table 4.
Hemangioma type__
Hemangioma type Number %
Superficial 136 49,3
Segmental 1 0,4
Deep 82 29,7
Mixed 57 20,7
Total 276 100,0
Our research's analysis and assessment of the Hemangiol treatment success rate is presented in the following tables and figures.
Oral treatment with Hemangiol was applied in 92.4% of the patients, and a combined treatment in 7.6% (Table 2)
Table 5
Treatment Number %
Oral (powder/syrup) 255 92,4
Combined 21 7,6
Total 276 100,0
Figure 2. Duration of Hemangiol treatment
The Hemangiol treatment duration was 4-6 months in 84,1% of the children, while it lasted over 6 months in 15,9%, which correlates to the type of the hemangioma and its localization.
The results of the effect of the treatment show that in 83,7% are discharged with a "clinically healthy" diagnosis, while 11,6% of children necessitated further treatment, and as little as 4,7% had recurrences of the condition.
Table 6.
Effect of the Hemangiol treatment
Treatment effect Number %
Clinically healthy 231 83,7
Further treatment needed 32 11,6
Recurrence 13 4,7
Total 276 100,0
Conclusion
The choice of adequate therapeutically approach for hemangioma in newborns is the object of longstanding dispute, which last even today. In the global
dermatological and pediatric practice, there isn't a unified approach to treating hemangioma in newborns.
The significant therapeutic response observed by Leaute-Lebreze et al. prompted us to apply in practice
this new systemic therapy method for complicated he-mangioma in newborns. Our clinical experience so far shows a reversal of the development of the skin changes as early as the first 1-3 weeks of the therapy. So far we have not observed the therapy's side effects described in the literature. In our opinions treatment with pro-pranolol with a dosage of 2 mg/kg/daily may be an effective and relatively safe method for treating heman-gioma in newborns. Further research and combining the experience of different specialist teams will be needed to create a standard therapy regimen and implement in-practice in our country.
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