ABSTRACT
Infantile hemangiomas (IH) are vascular tumors that often require timely treatment to reduce morbidity.1,2 The 2019 American Academy of Pediatrics (AAP) Clinical Practice Guidelines (CPG) for the Management of IH recommend referral to dermatology prior to 4 weeks of age, enabling timely treatment initiation.1 This study examines adherence to national guidelines and aims to identify barriers to appropriate referral timing & treatment. This retrospective cohort study examined IH patients, ages 0 to 24 months, referred to Phoenix Children’s Hospital (PCH) Dermatology from 1/1/2019 to 12/31/2020, following release of AAP CPG. Patients were categorized into age appropriate (≤4wks) or late (>4wks) referral groups. Associations of referral age w/ demographics/treatments were examined. Among 791 patients identified, 46 (6%) were appropriately referred at ≤4 weeks of age, 680 (86%) were referred late at >4 weeks of age, and 65 (8%) had missing referral dates. For the group of 343 patients who were referred and treated w/ propranolol, mean age at referral, initial dermatology visit, and propranolol initiation was 3.2, 3.8, & 4.2 months, respectively. No statistical differences (p≤0.05) were detected in gender, race, insurance, language, or rates of propranolol/timolol treatment between referral groups. Despite AAP recommendations, the vast majority of infants with IH are referred to PCH Dermatology after 4 weeks of age. Late referral has led to treatment initiation after the rapid growth phase in most patients, which is problematic for those w/ high-risk hemangiomas. Patient demographics were not correlated w/ referral category suggesting that other factors, such as primary care provider referral practices and the COVID-19 pandemic, may have contributed to delayed referrals. Based on mean age at referral and treatment initiation, patients may have already experienced complications from their hemangiomas, which could result in increased healthcare utilization, costs, & morbidity. References: 1) Krowchuk DP et al. Clinical Practice Guideline for the Management of Infantile Hemangiomas: American Academy of Pediatrics. Pediatrics, Jan 2019;143(1). 2) Tollefson MM and IJ Frieden. Early growth of infantile hemangiomas: what parents;photographs tell us. Pediatrics, Aug 2012;130(2): e314-20.