Adverse effects of systemic glucocorticosteroid therapy in infants with hemangiomas.
OBJECTIVE
To evaluate the short- and long-term adverse effects of systemic glucocorticosteroid (GS) therapy in infants with hemangiomas.


METHODS
Retrospective chart review of infants treated with GSs for hemangiomas during a 3-year period.


METHODS
Tertiary care children's hospital.


METHODS
Of 141 patients identified with hemangiomas, 22 were treated with GSs.


METHODS
Minimum of 1-month GS therapy at a minimum starting dose of 0.5 mg/kg per day.


METHODS
Demographic and anthropometric measurements, starting dose and duration of GS therapy, subjective parental concerns, complications related to hemangioma, adjunctive treatment, and morning cortisol levels and/or results of corticotropin stimulation tests.


RESULTS
The average starting dose was 2.23 mg/kg per day; average length of therapy was 28.1 weeks. Complaints of irritability, fussiness, or insomnia were identified in 16 patients (73%). Hypertension, defined as 3 or more episodes of systolic blood pressure higher than 105 mm Hg, was observed in 10 patients (45%). Morning cortisol levels were abnormal in 13 (87%) of the 15 patients evaluated. Low-dose corticotropin stimulation test results were abnormal in 2 of the 3 infants tested.


CONCLUSIONS
While GS therapy for infantile hemangiomas was tolerated well overall, changes in behavior, insomnia, and gastrointestinal symptoms were common parental concerns. Hypertension and hypothalamic-pituitary-adrenal axis suppression were observed frequently. Infants undergoing long-term GS treatment of hemangiomas should be monitored carefully for these potential adverse effects.
Section of Dermatology, Children's Mercy Hospital, Kansas City, MO, USA. mgeorge@kumc.edu
Manju E
ME
George
Vidya
V
Sharma
Jill
J
Jacobson
Stephen
S
Simon
Amy Jo
AJ
Nopper
D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006391:Hemangioma / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D008297:Male; D008499:Medical Records; D008923:Missouri / Q000453:epidemiology; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology
D005938:Glucocorticoids