Diagnosis and Management of Infantile Hemangioma

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Figure 2. Analytic framework for KQ2 and KQ3 IH = infantile hemangioma; KQ = Key Question Figure 3. Analytic framework for KQ4 IH = infantile hemangioma; KQ = Key Question; Nd:YAG = neodymium yttrium aluminum garnet Organization of This Report The Methods section describes the review processes including search strategy, inclusion and exclusion criteria, approach to review of abstracts and full publications, methods for extraction 5
of data, and compiling evidence. We also describe our approach to grading the quality of the literature and describing the strength of the body of evidence. The Results section presents the findings of the literature search and the review of the evidence by Key Question, synthesizing the findings across strategies. We present findings for the Contextual Questions followed by findings of the network meta-analysis, followed by findings for each Key Question organized by intervention and outcome area where possible. Summary tables for each Key Question outline key outcomes. The Discussion section of the report discusses the results and expands on methodologic considerations relevant to each Key Question. We also outline the current state of the literature and challenges for future research in the field. The report includes a number of appendices to provide further detail on our methods and the studies assessed. The appendices are as follows: • Appendix A: Search Strategies • Appendix B: Screening and Quality Assessment Forms • Appendix C: Excluded Studies • Appendix D: Methods for Network Meta-Analysis • Appendix E: Study Design Classification Algorithm • Appendix F: Quality/Risk of Bias Ratings • Appendix G: Applicability Tables • Appendix H: Harms Reported in Package Insert Data and Other Sources We also provide a list of abbreviations and acronyms at the end of the report. Uses of This Evidence Report We anticipate this report will be of primary value to organizations that develop guidelines for managing IH, to clinicians who provide care for children with IH, and for families making treatment decisions. IH is diagnosed and treated by clinicians including pediatricians, dermatologists, otolaryngologists, family physicians, nurses, nurse-practitioners, physician assistants, hematologists, and general and plastic surgeons. This report supplies practitioners and researchers up-to-date information about the current state of evidence, and assesses the quality of studies that aim to determine the outcomes and safety of treatments for IH. Researchers can obtain a concise analysis of the current state of knowledge of interventions in this field. They will be poised to pursue further investigations that are needed to advance research methods, develop new treatment strategies, and optimize the effectiveness and safety of clinical care for children with this condition. 6
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 and 16: for contextual questions as few eff
Page 17 and 18: Figure B. Analytic framework for KQ
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: KQ2. Among newborns, infants, and c
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
Page 67 and 68: Table 3. Characteristics of include
Page 69 and 70: scans, had a sensitivity of 20 perc
Page 71 and 72: of the model fit to all studies, bu
Page 73 and 74: Detailed Analysis Effectiveness of
Page 75 and 76: Table 6. Key resolution outcomes in
Page 77 and 78: with prednisolone included endocrin
Page 79 and 80: children in 8 studies), skin atroph
Page 81 and 82: hypopigmentation, impaired wound he
Page 83 and 84: fair quality for effectiveness outc
Page 85 and 86: studies of nadolol and atenolol. No
Page 87 and 88: Table 10. Key resolution outcomes i
Page 89 and 90: old. 100 Thirty percent of children
Page 91 and 92: Table 11. Resolution outcomes in st
Page 97 and 98: Table 15. Key outcomes in studies c
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Table 19. Key resolution outcomes i
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Table 21. Resolution outcomes in st
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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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119. Sharma LK, Dalal SS. Corticost
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162. Snir M, Reich U, Siegel R, et
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198. Chen ZG, Zheng JW, Yuan ML, et
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237. Healy G, McGill T, Friedman EM
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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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65. Dachman AH, Lichtenstein JE, Fr
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111. Yoshida T, Kuratomi K, Mitsuma
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160. Newman SL, Goodwin CD. Colonic
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204. Crockett DM, Healy GB, McGill
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253. Wright GL, Smith RJ, Katz CD,
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301. Paley D, Jackson RW. Synovial
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346. Dombrowski MP, Budev H, Wolfe
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390. Stringel G. Giant hemangioma:
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436. Liu HC, Chang MH, Lue HC, et a
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526. Taylor RS, Joseph DB, Kohaut E
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3201. Nale P. Propranolol treatment
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3243. Soltani AM, Reinisch JF. Algo
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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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