Adverse Effects of Systemic Glucocorticosteroid Therapy in Infants With Hemangiomas

Abstract

OBJECTIVE: To evaluate the short- and long-term adverse effects of systemic glucocorticosteroid (GS) therapy in infants with hemangiomas. DESIGN: Retrospective chart review of infants treated with GSs for hemangiomas during a 3-year period. SETTING: Tertiary care children's hospital. PATIENTS: Of 141 patients identified with hemangiomas, 22 were treated with GSs. INTERVENTIONS: Minimum of 1-month GS therapy at a minimum starting dose of 0.5 mg/kg per day. OUTCOME MEASURES: 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.