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Management of Infantile Hemangiomas During the COVID Pandemic
abstract
This abstract is available on the publisher's site.
Access this abstract nowThe COVID-19 pandemic has caused significant shifts in patient care including a steep decline in ambulatory visits and a marked increase in the use of telemedicine. Infantile hemangiomas can require urgent evaluation and risk stratification to determine which infants need treatment and which can be managed with continued observation. For those requiring treatment, prompt initiation decreases morbidity and improves long-term outcomes. The Hemangioma Investigator Group has created consensus recommendations for management of infantile hemangiomas via telemedicine. FDA/EMA approved monitoring guidelines, clinical practice guidelines and relevant, up-to-date publications regarding initiation and monitoring of beta-blocker therapy were used to inform the recommendations. Clinical decision-making guidelines about when telehealth is an appropriate alternative to in-office visits, including medication initiation, dosage changes, and ongoing evaluation are included. The importance of communication with caregivers in the context of telemedicine is discussed and online resources for both hemangioma education and for propranolol therapy provided.
Additional Info
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Management of Infantile Hemangiomas During the COVID Pandemic
Pediatr Dermatol 2020 Apr 16;[EPub Ahead of Print], IJ Frieden, KB Püttgen, BA Drolet, MC Garzon, SL Chamlin, E Pope, AJ Mancini, CT Lauren, EF Mathes, DH Siegel, D Gupta, AN Haggstrom, MM Tollefson, E Baselga, KD Morel, SD Shah, KE Holland, DM Adams, KA Horii, BD Newell, J Powell, CC McCuaig, AJ Nopper, DW Metry, S MaguinessFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This manuscript was written by the Hemangioma Investigator Group members and submitted for rapid review and publication to help providers treat infants with infantile hemangiomas (IH) during the COVID pandemic and beyond. The recommendations combine evidence and experience to risk stratify those infants with IH most appropriate for telemedicine evaluation and care including home initiation of a topical or oral beta-blocker. Higher risk characteristics of IH patients where weighing of risks and benefits favors in-person evaluation, except in unusual circumstances, are also detailed. These higher risk attributes include corrected gestational age < 5 weeks, abnormal cardiovascular examination, those at risk for an associated IH syndrome and many others. For those at standard risk, outpatient propranolol initiation at a low dose of 0.5mg/kg/day divided BID with gradual increasing was a suggested approach. Pearls for telephone or video follow-up are also included.
Moreover, counseling and education about IH and therapy are critical to anticipatory guidance, to minimize side effects and are a potential challenge with telehealth visits. Table 3 lists on-line educational resources including a video link for caregiver education about propranolol administration.