Factors associated with delayed referral for infantile hemangioma necessitating propranolol

Abstract

Background

Oral propranolol is the gold-standard to treat infantile hemangiomas. There is better efficacy and a lower risk of sequelae if therapy is started before the end of the growth phase, but most children are referred too late. Herein, we report the first study to investigate the delay and its associated factors when referring infants with infantile hemangiomas that need propranolol therapy.

Objectives

The primary objective was to determine the delay in referral (time between age at referral [first phone contact] and the optimal age for referral (fixed at 75 days). The second objective was to determine the impact of weighted factors associated with delayed referral assessed by logistic regression performed on two subgroups (referral <75 vs. >75 days).

Methods

Monocentric, retrospective, observational study included infants with infantile hemangiomas treated with oral propranolol between August 2014 and May 2017.

Results

82 children (83% females) were included. Before referral, 81 (99%) children had seen another physician (a pediatrician in 67% of cases). Median age at referral was 99 [2-478] days and 63% phoned after 75 days. Median age at the first visit was 111 days [2-515] and median age when propranolol was started was 128 days [32-541]. After adjustment, in multivariate analyses, location on the lips (OR (CI_95%): 4.21[1.19–14.89]) and superficial hemangioma (OR (CI_95%): 4.19 [1.55–11.34]) emerged as the most significant factors to influence referral before 75 days.

Conclusions

This study adds to our understanding regarding delayed referral and has identified targets for future information campaigns.

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