Diagnosis and Management of Infantile Hemangioma

characterizing infantile hemangioma [IH]), one prospective comparative study that used an
untreated IH as a control, and 106 case series (used for harms data only). Most studies were
conducted in Europe (n = 51) or Asia (n = 44). Forty-one were conducted in the United States or
Canada and 12 in other countries including Australia, Egypt, Argentina, and Chile (Table 3).
Forty-two comparative studies reported effectiveness outcomes. We considered six of these
studies to be good quality, 22 fair quality, and 14 poor quality. One-hundred and forty-four
studies (comparative studies and case series) reported harms/adverse events data. We considered
14 of these as good quality for harms reporting, three as fair quality for harms reporting, and the
remainder (n = 127) as poor quality for harms reporting. Most studies addressed beta-blockers (n
= 81, 13 of which compared a beta-blocker to another category of intervention such as
corticosteroids or laser); 26 addressed lasers; 24 addressed steroids; 15 addressed surgical
approaches; and two addressed diagnostic modalities.
We included 18 studies in a network meta-analysis. All studies addressed pharmacologic
agents and included five RCTs and four cohort studies evaluating oral propranolol and placebo
or observation or another active agent, 92-100 including steroids; 96-98,100 one RCT and one cohort
study comparing propranolol and other beta-blockers; 101,102 three cohort studies and two RCTs
assessing topical timolol compared with placebo or observation or another agent; 14,103-106 and one
RCT and one cohort study comparing different steroids, including oral prednisone and
intralesional triamcinolone. 107,108 Four studies were good quality 92,98,104,107 ; nine were fair
quality 14,93,94,96,97,99,100,102,105 ; and five were poor quality. 95,101,103,106,108 Studies in the metaanalysis
included a total of 1265 children with IH.
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