Delayed Referral Common in Infantile Hemangioma in Need for Propranolol

Hemangioma, macro and micro.
Hemangioma, macro and micro.
The results of the current study contribute to the understanding of delayed referral in patients with infantile hemangioma.

Children with infantile hemangioma (IH) who require oral propranolol (OP) therapy are often referred for therapy too late, according to the results of a monocentric, retrospective, observational study conducted in Toulouse, France, and published in Journal of the European Academy of Dermatology and Venereology.

The primary objective of the study was to determine the delay in referral time (ie, the time between age at referral [initial telephone contact] and the ideal age for referral [fixed at 75 days]). A secondary objective was to establish the effect of weighted factors associated with delayed referral (ie, referral in ≤75 days vs >75 days). The study was conducted between August 2014 and May 2017.

A total of 82 children, 83% girls, were included in the study. Patients were divided into 2 subgroups: IHs referred at age ≤75 days, and IHs referred at age >75 days. Prior to referral, 99% (81 of 82) of the participants had been seen by another physician (67% with a pediatrician).

Median patient age at referral was 99 days (range, 2 to 478 days); 63% of phone calls were made at >75 days. The median patient age at the first visit was 111 days (range, 2 to 515 days); the median age when OP was initiated was 128 days (range, 32 to 541 days). The 2 main reasons for initiating OH therapy were disfigurement (53% of patients) and functional impairment (29% of patients).

Per univariate analysis, presence in group 1 had a significant association with the following features: onset of IH at birth/within the first month (odds ratio [OR] 4.77; 95% CI, 1.45-15.63; P =.01); location of IH on the lips (OR 4.7; 95% CI, 1.42-15.52; P =.01); and IHs that had a superficial component (superficial and mixed IHs: OR 10.68; 95% CI, 1.33-86; P =.03) or only a superficial component (OR 4.5; 95% CI, 1.72-11.76; P =.002).

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Following adjustment, location on the lips (OR 4.21; 95% CI, 1.19-14.89; P =.03) and being a superficial form of IH (OR 4.19; 95% CI, 1.55-11.34; P =.01) were the factors most significantly associated with delayed referral.

The investigators concluded that the results of the current study contribute to our understanding of delayed referral in patients with IH and helps to identify targets for organizing future information campaigns, with the ultimate goal being to improve care and prognosis in this patient population.


Onnis G, Dreyfus I, Mazereeuw-Hautier J. Factors associated with delayed referral for infantile hemangioma necessitating propranolol [published online February 6, 2018]. J Eur Acad Dermatol Venereol. doi:10.1111/jdv.14842