Recognize Blood Vessel Tumors (Hemangiomas) in Children, Is It Dangerous?

General Description

Infantile hemangioma (HI) is a type of vascular tumor that forms due to excessive growth of blood vessel cells (vascular endothelial cells). This condition can occur in newborns and is seen as red spots or a thickening of the skin. A small proportion of infantile hemangiomas can disappear on their own as children get older, but they can also cause serious problems if they are located in certain areas, such as around the eyes or mouth.

Signs and Symptoms

Infantile hemangiomas usually appear as a red spot or a red thickening. The physical appearance of an infantile hemangioma can vary depending on its location and size. Infantile hemangiomas that are located on the surface generally look like a reddish or blue thickening or lump. Infantile hemangiomas located in internal organs, such as the liver or brain, cannot be seen physically and can only be detected through special examinations such as ultrasonography (USG) or magnetic resonance imaging (MRI). Phases or changes in the state of infantile hemangioma can be explained as follows:

• Proliferation phase. The blood vessel cells continue to grow and cause an increase in the size of the hemangioma. This phase can occur several weeks after birth and last for several months.

• Plateau phase. Hemangioma growth began to slow down, and no significant change in size was seen. This phase usually occurs between the ages of 6 and 12 months and can last for several years.

• Involution phase. Blood vessel cells begin to disappear, and the hemangioma shrinks. This phase usually occurs between the ages of 2 and 5 and can last for several years. In some cases, infantile hemangiomas usually disappear completely by the end of this involution phase.

Risk Factors

Various studies have shown the possibility that there are biomolecular factors that influence changes in the growth properties of blood vessel cells, so that the formation of blood vessels becomes abnormal and too fast (hyperproliferation vasculogenesis). Several risk factors that can increase the likelihood of a baby experiencing infantile hemangiomas include: 

Gender : Baby girls are more likely to have infantile hemangiomas than baby boys.

Maternal age at gestation: older pregnant women are more likely to have a child with an infantile hemangioma.

Maternal pain during pregnancy: Pregnant women who experience excessive pain during pregnancy are more likely to have a child with an infantile hemangioma.

Smoking: Pregnant women who smoke are more likely to have a child with an infantile hemangioma.

Handling

Infantile hemangiomas can be treated by administering certain drugs, and if necessary, surgery can be carried out according to indications. The following are some treatment options for infantile hemangiomas :

Propranolol is a beta-blocker drug that works by reducing the production of hormones that cause blood vessels to grow. Propranolol is a first-line therapy that has been shown to be quite effective in treating hemangiomas. Prednisone is a drug that can also be used to treat infantile hemangiomas. Prednisone works by reducing inflammation and hemangioma size.

Surgical therapy is a treatment option for infantile hemangiomas located in certain areas, such as around the eyes or mouth, or if the hemangioma causes other problems such as breathing problems or is in a location prone to infection. For infantile hemangiomas located in these areas, surgical treatment may be considered. Surgical therapy for infantile hemangiomas is usually performed by a plastic surgeon or vascular surgeon who is trained in dealing with vascular problems. Several types of surgical therapy that can be performed to treat infantile hemangiomas include :

• Laser surgery (pulsed dye laser): use of a laser to remove part or all of the hemangioma tissue.

• Plastic surgery : a special surgical technique using donor skin or other tissue to cover the wound after the hemangioma has been removed.

• Embolization: A technique in which certain chemicals are used to block the blood vessels that supply blood to the hemangioma tissue.

Infant and toddler patients with a possible diagnosis of infantile hemangioma can also be consulted further with a pediatrician, a sub-specialist in hematology-oncology, and a surgeon in order to receive a more comprehensive treatment. 

The presence of a hemangioma condition can be detected by physical examination. The medical team can assess the child's health or detect the possibility of a hemangioma in the patient and plan its management. Parents can immediately consult a doctor at the nearest Hermina Hospital, and Friends of Hermina can also consult online with specialist doctors through the "Halo Hermina" application.

Referensi:

Chamli A, Aggarwal P, Jamil RT, et al. Hemangioma. [Updated 2022 Oct 25]. In: Stat Pearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538232/

Fei, Q., Lin, Y., & Chen, X. (2020). Treatments for infantile Hemangioma: A systematic review and network meta-analysis. EClinicalMedicine, 26. https://doi.org/10.1016/j.eclinm.2020.100506

Novoa, M., Baselga, E., Beltran, S., Giraldo, L., Shahbaz, A., Pardo-Hernandez, H., & Arevalo-Rodriguez, I. (2019). Interventions for infantile haemangiomas of the skin: abridged Cochrane systematic review and GRADE assessments. British Journal of Dermatology, 180(3), 527–533. https://doi.org/https://doi.org/10.1111/bjd.17407