Diagnosis and Management of Infantile Hemangioma

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KQ4. Among newborns, infants, and children up to 18 years of age with infantile hemangiomas who have been referred for surgical intervention, what is the comparative effectiveness (benefits/ harms) of various types of surgical interventions (including laser and resection)? Analytic Framework The analytic frameworks illustrate the population, interventions, and outcomes that guided the literature search and synthesis of comparative studies (Figures A-C). The frameworks depict the KQs within the context of the population, intervention, comparator, outcomes, timing, and setting (PICOTS) parameters described in the review. In general, the figures illustrate how imaging modalities or interventions such as magnetic resonance imaging (MRI), beta-blockers, or laser may result in intermediate outcomes such as change in hemangioma size or change in vision and/or in final health outcomes such as detection of hemangiomas for imaging modalities or resolution of hemangioma or changes in quality of life for medical or surgical treatments. Also, adverse events may occur at any point after imaging or receipt of the intervention. Figure A. Analytic framework for KQ1 IH = infantile hemangioma; KQ = Key Question ES-4
Figure B. Analytic framework for KQ2 and KQ3 IH = infantile hemangioma; KQ = Key Question Figure C. Analytic framework for KQ4 IH = infantile hemangioma; KQ = Key Question; ND:YAG = Neodymium Yttrium Aluminum Garnet ES-5
Page 1 and 2: Comparative Effectiveness Review Nu
Page 3 and 4: This report is based on research co
Page 5 and 6: Acknowledgments The authors gratefu
Page 7 and 8: Peer Reviewers Prior to publication
Page 9 and 10: BCI; moderate SOE for effects of pr
Page 11 and 12: Overview of the Literature ........
Page 13 and 14: Executive Summary Introduction Infa
Page 15: for contextual questions as few eff
Page 19 and 20: Table A. Inclusion criteria (contin
Page 21 and 22: precision (precise, imprecise), and
Page 23 and 24: Figure D. Estimates of expected IH
Page 25 and 26: majority of studies to date have in
Page 27 and 28: effectiveness outcomes. The evidenc
Page 29 and 30: changes. We considered the strength
Page 31 and 32: Table C. Summary of evidence in stu
Page 37 and 38: Table D. Summary of evidence in stu
Page 39 and 40: Applicability We set inclusion crit
Page 41 and 42: quantitative meta-analyses. Researc
Page 43 and 44: surgically. Lesion characteristics
Page 45 and 46: References 1. Wassef M, Blei F, Ada
Page 47 and 48: 39. Yu L, Li S, Su B, et al. Treatm
Page 49 and 50: modalities. The questions of imagin
Page 51 and 52: KQ2. Among newborns, infants, and c
Page 53 and 54: of data, and compiling evidence. We
Page 55 and 56: We only included studies published
Page 57 and 58: a standardized form (Appendix B) th
Page 59 and 60: Determining Quality Ratings • We
Page 61 and 62: Results We present results for Cont
Page 63 and 64: defects, urogenital anomalies, ulce
Page 65 and 66: Results of Literature Searches for
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Table 3. Characteristics of include
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scans, had a sensitivity of 20 perc
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of the model fit to all studies, bu
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Detailed Analysis Effectiveness of
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Table 6. Key resolution outcomes in
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with prednisolone included endocrin
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children in 8 studies), skin atroph
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hypopigmentation, impaired wound he
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fair quality for effectiveness outc
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studies of nadolol and atenolol. No
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Table 10. Key resolution outcomes i
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old. 100 Thirty percent of children
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Table 11. Resolution outcomes in st
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Table 15. Key outcomes in studies c
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Table 22. Harms/adverse effects in
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Table 24. Adverse effects in case s
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Table 24. Adverse effects in case s
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• In two RCTs reporting level of
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Nd:YAG Laser With Cooling Compared
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long term follow information was av
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Discussion State of the Literature
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Table 34. Strength of evidence for
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Effectiveness and Harms of Beta-Blo
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older children. One comparative stu
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case series reporting on rarer pres
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agents is critical, especially as u
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References 1. Wassef M, Blei F, Ada
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39. Chen TS, Eichenfield LF, Friedl
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80. Mai HM, Zheng JW, Wang YA, et a
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Abbreviations and Acronyms Used in
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Appendix A. Search Strategies Searc
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Searches for Comparative Effectiven
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Appendix B. Screening and Quality A
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Harms Risk of Bias Assessment Form
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QUADAS Diagnostic Accuracy Rating T
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Infantile Hemangioma CER: Risk of B
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20. Grundfest-Broniatowski S, Carey
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where ΦΦ(xx) is the cumulative di
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Figure D-1. Estimates of expected I
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Figure D-3. Posterior SUCRA estimat
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Figure D-5. Network diagram of comp
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Appendix E. Study Design Classifica
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Author, Year Hogeling 2011 10 Alloc
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Author, Year Representativeness of
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Author, Year Were the harms predefi
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25. Qiu Y, Ma G, Yang J, et al. Imi
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56. Hassan BA, Shreef KS. Propranol
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88. Chakkittakandiyil A, Phillips R
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120. Pandey A, Gangopadhyay AN, Gop
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Appendix G. Applicability Tables Ta
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Appendix H. Harms Reported in Packa
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o Acquired (autoimmune) hemolytic a
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o Ankylosing spondylitis o Dermatom
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H-7 • Increased dosage of rapidly
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Elocon® (mometason e furoate) 11 T
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Timoptic® (timolol maleate) 15 Tim
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Harms Data for Medications Included
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Table H-3: Adverse Events from Flo-
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(
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thromboembolism, thrombophlebitis,
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grades): 103 (48%), erosion/ulcerat
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acute myocardial infarction: 3 (Rat
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Discontinuations Patients utilizing
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ocular irritation including blephar
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Diagnosis and Management of Infantile Hemangioma

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