Diagnosis and Management of Infantile Hemangioma

with prednisolone included endocrine (n=0.18% of lesions), gastrointestinal (n=0.14% of
lesions), growth and development (n=0.23% of lesions), infection (n=0.09% of lesions),
metabolic (n=0.02% of lesions), and pulmonary/respiratory (n=0.11% of lesions). Severe adverse
events occurred more frequently in the prednisolone arm (11 vs. 1 in propranolol arm, p=0.01).
Nine of the 11 severe events were related to growth restriction. Fewer children in the
prednisolone arm had pulmonary events (typically upper respiratory tract infection) compared
with children in the propranolol group (5 vs. 14, p70%) in
both arms in this study also experienced blood pressures ≥ the 90 th percentile (>15% in either
arm were ≥ the 95 th percentile) though only one required antihypertensive medication for
persistent elevation, and 52 of 73 cortisol tests were abnormal (31 in prednisolone arm and 21 in
methylprednisolone). Twelve cortisol levels in the prednisolone arm and one in the
methylprednisolone arm were in the undetectable range, and blood glucose was transiently
elevated in 5 of 70 tests. 107 In total, seven of 330 participants receiving steroids in comparative
studies discontinued treatment due to adverse events.
Table 8. Harms/adverse effects in comparative studies of steroids to treat IH
N Studies Reporting
Intervention
Harm/Adverse Event
Harm (# Participants
With Harm/Total
Participants)
Prednisolone 2-2.6
mg/kg/day
Reported Rates
Across Studies
Irritability 107 1 (3/10) 30%
Crying 107 1 (3/10) 30%
Insomnia 107 1 (3/10) 30%
Hyperactivity 107 1 (2/10) 20%
Vomiting 107 1 (2/10) 20%
Abdominal pain or
2 (5/20) 20%-30%
gastrointestinal distress 100,107
Ulceration or infection 100,108 2 (5/35) 10%-16%
Persistent high blood
1 (1/10) 10%
pressure 107
Respiratory distress 107 1 (1/10) 10%
Chickenpox 107 1 (1/10) 10%
Cushingoid appearance 100 1 (5/10) 50%
Failure to thrive 100 1 (1/10) 10%
30