Journal List > Korean J Perinatol > v.26(3) > 1013757

Kim, Lee, Shin, M.D., Kim, Kim, Kim, and Choi: Clinical Manifestations of Capillary Hemangiomas in Preterm Infants

Abstract

Purpose

Capillary hemangiomas occur more frequently in preterm infants. We aimed to describe the clinical course of capillary hemangiomas in preterm infants.

Methods

The records of preterm infants with a gestational age (GA) of <35 weeks who were admitted to two tertiary neonatal intensive care units from January 2004 to December 2013 and had capillary hemangiomas were reviewed retrospectively. Subgroup analysis of between infants of GA <30 weeks and GA 30–34+6 weeks were done and ad hoc analysis comparing study population and matched preterm infants without hemangioma for investigation of differences in clinical characteristics.

Results

Of the 2,772 preterm infants, 112 (4%) infants developed capillary hemangiomas. The majority (91.9 %) of them had a solitary hemangiomas with the trunk was the most commonly involved site (43%). Three quarters of the patients were treated with topical corticosteroid, propranolol or laser treatment. When we divided this population as who were born before or after GA 30 weeks, there was no difference at postmenstrual age (PMA) of onset of capillary hemangiomas (median [IQR], 36+4 [30+5–40+5] vs. 36+2 [33+6–41+1] weeks, P= 0.275). The age at involution of capillary hemangiomas was also not differ between two groups (median [IQR], 7.75 [3.75–12.25] vs. 7.5 [4–13.75] months, P=0.425). There were no statistical differences between preterm infants with capillary hemangiomas and their age, weight and sex matched control preterm infants without hemangiomas in the neonatal and maternal factors.

Conclusion

The development of capillary hemangiomas occurred at approximately 36 to 37weeks of PMA regardless of prematurity in preterm infants. Capillary hemangiomas of preterm infants resolved spontaneously and disappear completely by around 7 months of corrected age.

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Fig. 1.
The majority (91.9%) of the preterm infants had a solitary hemangiomas, and 9 (34.5%) had two to three lesions. Lesions were most commonly found on the trunk (43%), head and neck (35%), and extremities (22%).
kjp-26-222f1.tif
Table 1.
Diagnosis and Improved Time of Capillary Hemangiomas According to GA Subgroups
  GA <30 wk (n=34) GA 30–34+6 wk (n=77) P-value
Onset of hemangiomas
PNA (days) 65 (20.5–108.5) 24 (14–59) 0.009
PMA (weeks) 36+4 (30+5-40+5) 36+2 (33+6-41+1) 0.275
Involution time (CA, month) 7.75 (3.75–12.25) 7.5 (4–13.75) 0.425

Values are expressed as median (IQR). Abbreviations: GA, gestational age; PMA, postmenstrual age; PNA, postnatal age; CA, corrected age.

Table 2.
Neonatal and Maternal Characteristics of the Case and Control Groups (GA <35 weeks)
  Hemagiomas (n = 93) Control (n = 93) P-value
Baseline characteristics
Gestational age, median (IQR), wk 30+3 (28+2-32+0) 30+3 (28+2-32+0) 0.98
Gender (male:female) 49:44 (1:0.89) 51:42 (1:0.82) 0.77
Birth weight, mean (SD), g 1,310 (421) 1,303 (419) 0.91
Small for gestational age (<10 percentile) 28 (30.1) 19 (20.4) 0.129
Multiple birth 44 (47.3) 43 (46.2) 0.88
Vaginal delivery 32 (34.4) 34 (36.5) 0.76
Length of hospitalization (day), median (IQR) 46 (33–80) 55 (30–74) 0.964
Maternal factors
Maternal age median (IQR), year 32 (31–34) 32 (30–34) 0.540
Preeclampsia 20 (21.5) 12 (12.9) 0.12
GDM 7 (7.5) 10 (10.7) 0.445
PROM (>18hr) 40 (43.0) 42 (45.1) 0.768
Antenatal steroids 60 (64.5) 62 (66.6) 0.758
Chorioamnionitis 29 (31.1) 42 (45.1) 0.05
Oligohydramnios 11 (11.8) 12 (12.9) 0.824
Clinical factors
1-min Apgar score, median (IQR) 5 (4–7) 5 (3–6) 0.106
5-min Apgar score, median (IQR) 7 (6–8) 7 (6–8) 0.159
Respiratory distress syndrome 52 (55.9) 42 (45.2) 0.142
PDA 41 (44.1) 36 (38.7) 0.457
Moderate to severe BPD 15 (16.1) 16 (17.2) 0.844
Mechanical ventilator care 72 (77.4) 76 (81.7) 0.467
Mechanical ventilation, median (IQR), day 7 (1–40) 8 (3–40) 0.431
Congenital heart disease 14 (15.1) 6 (6.5) 0.058
Hypothyroidism 17 (18.3) 16 (17.2) 0.848
Necrotizing enterocolitis 9 (9.7) 6 (6.5) 0.419
Retinopathy of prematurity 23 (34.7) 28 (30.1) 0.411
Duration of TPN, median (IQR), day 11 (5–19) 10 (6–17) 0.672
Full feeding reach (full feeding r median (IQR), day 11 (7–18) 10 (6–17) 0.246

Values are reported as No. (%) unless otherwise indicated.

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