Infantile Haemangioma Treatment in Mumbai, India

Infantile haemangioma is excessive growth and multiplication of blood vessels in an infant that appears as a birthmark. These are the most common forms of birthmarks and occur in 4-5% of infants. Some infants are born with infantile haemangioma, while in some, it appears during the first few weeks after birth.

Associated Anatomy

 Infantile haemangioma is more common in girls. Also, 18-30% of infantile haemangioma occurs on the extremities. Distal location of extremities is affected most commonly.

Alternate Name

Infantile haemangioma is also known as Strawberry birthmarks due to its appearance. Other alternative names are cavernous haemangioma, strawberry nevus, birthmark haemangioma.

Infantile Haemangioma Symptoms    

Most common signs associated with infantile haemangioma that are superficial include:

• Bumpy patches on the skin
• Red or blue patches
• Appear immediately after birth or within a few weeks
• Soreness
• Bleeding but in rare cases
• Deep infantile haemangiomas are present under the skin. These can grow toward the eyes, nose, or ear. Their growth can block the airway and affect eyesight.

If the haemangioma is present in internal organs, specifically the gastrointestinal tract or liver, the associated symptoms might include:

• Nausea
• Abdominal discomfort
• Loss of Appetite
• Vomiting

Infantile Haemangioma Causes

• The blood vessels grow at an abnormal pace in infantile haemangioma. The exact cause for this is unknown, but it occurs commonly in premature infants with low birth weight, twins, or triplets.
• GLUT1 protein of the placenta is also associated with infantile haemangioma. 
• Defect in the regulation of vascular stem cells also leads to abnormal growth of blood vessels. 
• The external factors influencing vascular anomalies included hypoxia and developmental disturbances in vascular tissues.

Infantile Haemangioma Stages

Infantile haemangioma goes through the following phases:

• Proliferative Phase: Haemangioma undergoes rapid growth at an early phase. It can extend from 4-8 weeks of life up to several months.
• Plateau Phase: During this phase, the vascular system in haemangioma becomes stable. During this phase, there is no growth and shrinking.
• Involution Phase: During this phase, the haemangioma starts to shrink. It usually begins after the first year of life. Infantile haemangiomas complete involution phase by the age of 5 years

Typical Test for Infantile Haemangioma

The superficial infantile haemangioma can be recognized based on appearance. For deep tissue, the infantile hematoma can be diagnosed with the help of MRI, CT scan, and ultrasounds. It also helps to understand the extent of the spread of haemangioma. If haemangioma is associated with other conditions, additional tests will be required.

Infantile Haemangioma Possible Treatment

Most haemangioma stops growing after the first year after birth. Cases with symptoms like vision defect, occurrence on an internal organ, soreness of the skin, or bleeding require treatment. These treatment options are as follows:

• Medication: Beta-blockers that lower the blood flow and slow down the growth of haemangioma
• Corticosteroids: Steroids can decrease the pace of the growth in haemangioma if used in the early phases.
• Interferons: These are used as a last resort to treat haemangiomas if beta-blockers and corticosteroids do not work.
• Another treatment option includes laser therapy to make it appear light and shrink its size.
• Radiotherapy also helps to arrest the excessive proliferation of endothelial cells in the vascular system of infantile haemangioma,
• Surgery: Infantile haemangiomas can be removed surgically. The surgery is not possible before the child reaches the age of 3-5 years.

Infantile Haemangioma Preventions

 The exact cause of infantile haemangioma is not known. There are no preventive measures for the proliferation of blood vessels in the condition. This benign vascular haemangioma also has a genetic predisposition, so it cannot be prevented.

Infantile Haemangioma Diagnosis

• Angiosarcoma
• Capillary malformation
• Cutaneous Lipoma
• Infantile fibrosarcoma
• Lipoblastoma
• Oral Lymphangioma
• Cherry Haemangioma
• Venous Malformations

Infantile Haemangioma Risk Factors

• Risk factors associated with the development of infantile haemangioma include female gender, low birth weight, and premature birth.
• Other less common risk factors include progesterone therapy and antenatal vaginal bleeding. 
• Multiple gestations and a family history of haemangioma is also a risk factor.

Infantile Haemangioma Complications

• Ulceration, bleeding, and infection are comparatively rare and occur in 15% of cases.
• Blockage of the airway and difficulty breathing if haemangioma occurs in close vicinity of the respiratory tract. 
• Ulceration of facial haemangioma can cause scarring and disfigurement, leading to permanent disfigurement of the face. 
• Haemangioma occurring on the eyelid can put excessive pressure on the retina, optical nerve, and corona. It can harm the vision of the child permanently.

Epidemiology

• Approximately 30% of infantile haemangiomas occur at the time of birth. 
• 70-90% of infantile haemangiomas occur within the first four weeks of life. Hence the incidence of infantile haemangioma is 1.1 - 2.6% in newborns and increases to approximately 12% by one year of age. 
• Infantile haemangioma occurs in infants worldwide, but the incidence is more in Caucasian infants (69%). The female to male ratio is 2.4: 1.0

Expected Prognosis

About 50% of cases of infantile haemangioma undergo complete involution by the age of five years. 70 % of cases of infantile haemangioma undergo complete involution by the age of seven years. 90 % of cases of infantile haemangioma undergo complete involution by the age of 9 years.

Pathophysiology

Infantile haemangioma contains plump endothelial cells that are proliferative. Angiogenic factors stimulate the proliferation of immature endothelial cells. Along with this, cytokines and growth factors help in the formation of the capillary networks. The endothelial cells are immature and disorganized during early proliferative stages but later organize to form vascular space. With age, the vessel spaces enlarge and their number decreases, leading to their involution. Along with endothelial cells, these vascular haemangiomas also acquire pericytes and adipocytes with time.