What evidence is available?See the evidence matrix in Epistemonikos below.
We found nine systematic reviews [2–4,9,10,13–16], including 10 primary studies [5,11,17–24], three of which are randomized trials [5,11,17].
What type of patients did the studies include?1
All trials [5,11,17] included patients diagnosed with infantile hemangioma needing treatment. This was defined by two trials [5,17 ] as the presence of functional impairment, cosmetic disfigurement, ulceration, or localization in fold areas, while the other trial [11] defined it as hemangiomas greater than or equal to 1.5 centimeters on the face, 3.0 centimeters outside the face, or 1.5 centimeters if ulceration was present. The average age of the patients included in the trials was 2.8 months.Regarding exclusion criteria, all three trials [5,11,17] excluded patients with contraindications to beta-blocker use, including previous history of allergy or hypersensitivity, heart disease, arrhythmias, asthma, or bronchial obstruction. One trial [17] excluded patients with type-2 diabetes mellitus, a history of hypoglycemia, hypertension or arterial hypotension, hepatic failure, carriers of visceral hemangiomas, PHACES syndrome, and preterm infants with correctional age less than 40 weeks.In addition, two studies [5,11] excluded patients previously treated with any therapy for infantile hemangioma.
What type of interventions were included in the studies?1
All trials [5,11,17] compared the use of atenolol versus propranolol as monotherapy.Atenolol doses were at 1 mg/kg/day in a daily dose for six months for one trial [5], 0.5 mg/kg/day for 24 hours, and then 1 mg/kg/day in a daily dose for nine months for another trial [17]; and 0.5 mg/kg/day for one week and then 1 mg/kg/day in a daily dose for six months for another study [11].As for propranolol doses, they were 2 mg/kg/day divided into three daily doses for six months for one trial [5]; 1 mg/kg/day, and then 2 mg/kg/day divided into two daily doses for nine months for another trial [17]; and 1 mg/kg/day for one week and then 2 mg/kg/day divided into three daily doses for six months for another study [11].
What type of outcomes were measured?
Trials reported multiple outcomes, which were grouped by the systematic reviews as follows:
Complete remission
Decrease in Hemangioma Activity Score
Post-treatment relapse
Adverse events
Severe adverse events
The average follow-up of the trials was 12 months, ranging from six to 24 months.
