Infantile hemangiomas thicker with steeper borders in preterm infants

Key takeaways:

• 75% of infantile hemangiomas among preterm infants born before 33 weeks were superficial.
• They were also thicker (P < .001) and had more stepped borders (P < .001) compared with cases among term infants.

Preterm infants more often presented with infantile hemangiomas that were thicker with steeper borders compared with term infants, signaling a need for improved treatment, according to a study.

“While a previous study comparing term and preterm infantile hemangiomas (IH) demonstrated an increased number of IH and decreased female-to-male ratio in preterm infants, whether other characteristics of IH in preterm infants differ from term infants has not been well characterized,” Flora E. Bradley, MD, a third-year dermatology resident at the University of California, San Francisco, School of Medicine, and colleagues wrote. “This study analyzes the clinical features of localized IH in preterm and term infants, with a focus on features associated with risk for cutaneous sequelae.”

The retrospective study included 830 preterm (21%) and term (79%) patients with localized IH. Thirty percent of the preterm infants were born before 33 weeks, whereas the remaining were born between 33 and less than 37 weeks.

Results showed that superficial IHs were the most common subtype of IH to present in infants. However, preterm infants born before 33 weeks were disproportionally affected by superficial IHs at a 75% incidence rate compared with 57% in infants born between 33 and less than 37 weeks and 50% in term infants (P = .007).

Preterm infants also saw thicker superficial and mixed IHs at a much higher frequency than other infants, as well as more stepped borders (P < .001 for both).

“While an increased risk of IH in preterm infants has been known for several decades, our study shows an additional and clinically important finding, that IH in preterm infants are thicker with more steep borders, features that are known to have a greater potential for adverse skin outcomes,” the authors wrote.

While there was no difference in chronological age for presentation to a pediatric dermatologist, the authors did notice that infants with stepped vs. progressive borders presented approximately 2 weeks later (5.8 vs. 5.2 months; P = .0063). According to the authors, current guidelines recommend that high-risk IHs be treated before age 2 to 3 months to be most effective.

“Our findings — if confirmed by other studies — suggest that there may need to be a paradigm shift in management of preterm infants with IH,” Bradley and colleagues wrote.

Among the changes that should be implemented are having frequent evaluations within the first few weeks after IH diagnosis to see if treatment is needed, serial follow-up evaluations and, if necessary, treatment while the infant is still an inpatient.