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So, let’s figure out what a hemangioma of newborns is and why it occurs.
A hemangioma is a benign skin tumor that consists of cells on the inner surface of blood vessels. These cells enter various organs and tissues, resulting in a formation, usually bright red or bluish in color. It can be at the level of the skin, or it can rise above it, or, conversely, be located in the depths of the tissues. The localization of the tumor can be very different: most often it is the head, face, neck, but also hemangiomas are found on the back, abdomen, arms, legs.
According to statistics, hemangiomas occur in 10 percent of newborns, and most often in girls.
The peculiarity of infantile hemangioma is that it either exists in a child already at birth, or appears in the first two months after childbirth. At first, the formation actively grows, but then the growth stops and the hemanginoma begins to decrease and eventually disappears. However, there are many cases when a newborn hemangioma requires complex treatment and removal.
Causes of hemangioma in newborns
“As for the causes of hemangiomas in newborns, there is still no exact answer to the question of why they appear,” says Grigory Somsikov, Head of the Department of Vascular Surgery, Children’s City Clinical Hospital of St. Vladimir in Moscow, Pediatric Surgeon, Specialist in Pediatric Vascular Pathologies. “There are only theories. One of them is the viral diseases of the mother during pregnancy, namely in the first trimester, when the formation of the vascular system of the unborn baby takes place. The risk of hemangiomas is also higher with the following factors:
- multiple pregnancies;
- the woman’s age is over 38;
- the birth of a premature baby;
- Rh-conflict of the child and mother;
- problems in the endocrine system of the baby or mother;
- increased blood pressure during pregnancy.
However, hemangiomas often occur in completely healthy children when the pregnancy proceeded safely, without pathologies.
Types of hemangioma in newborns
There are several types of hemangiomas in newborns.
Infantile (infantile) hemangioma. It consists of capillaries, may be purple or bluish in color, of different sizes, may be flat or slightly rise above the skin. If you press on the hemangioma, it turns pale. Education can be located on any part of the body, but most often occurs on the head, face, neck.
Combined hemangioma. It consists of pathological vascular formations, which are located both on the surface of the skin and in its deep layers, subcutaneous fat.
congenital hemangioma. This is a special type of hemangiomas, when a newborn is born immediately with a vascular tumor, as a rule, it is quite large. Color – dark burgundy with a white area in the center. Such formations are rare.
“In addition, hemangiomas can form on internal organs, such as the liver, spleen, brain,” says Grigory Somsikov. – It is worth noting that internal hemangiomas occur, as a rule, when there are a large number (more than 5) of hemangiomas on the skin.
As we have already said, hemangioma can appear on any part of the body of a newborn.
On the head
Formations on the scalp occur in the vast majority of cases of hemangiomas in newborns. It can be flat and barely noticeable (if the newborn has a fairly strong hairline, then the formation may not be noticed immediately), or it can be quite large, rising strongly above the skin.
On the face
On the face, hemangiomas are also very common. Moreover, they can be located on a variety of its parts: the bridge of the nose, cheeks, chin, eyelids, lips, ears. Hemangiomas located on the face always require special attention, as they can adversely affect the development of vital functions, such as vision, hearing. Such hemangiomas require early complex treatment. Formations on the neck can also be especially dangerous, as they can grow into the larynx, trachea, disrupting breathing, making it impossible to eat.
On the back
On this part of the body, formations are less common. As a rule, simple flat hemangiomas on the back do not cause discomfort to the newborn. But larger formations can be dangerous, because due to friction on clothes, constant squeezing while the child is lying, sleeping, increases the risk of ulcers, hemangioma trauma, and bleeding. Such formations require complex treatment.
On your feet
On the legs, hemangiomas do not occur often. But they can also cause discomfort and have a risk of injury if, for example, they have a large convex shape, are located on the joint, there is a risk of damage to the joint and bone tissue.
On hand
The same goes for hemangiomas on the hands. Particularly dangerous and requiring treatment can be combined formations located in the armpit, on the joints.
On the eyelid
On the eyelids, hemangiomas occur quite often and in almost one hundred percent of cases require treatment, since during the phase of active growth they can damage the eye of a newborn, lead to negative consequences in the development of vision. But the tactics of treating or removing hemangioma in this area should be chosen by the doctor especially carefully, since any intervention in the eye area also has serious risks.
On the lip
Hemangioma on the lip is not only a cosmetic defect. Such a formation can be dangerous, because as it grows, it can prevent the newborn from sucking, make breathing difficult, and close the entrance to the nasal cavity.
Treatment of hemangioma in newborns
Any newborn who has a hemangioma should be seen regularly by a vascular specialist. It is he who makes the final diagnosis and chooses the tactics of treating hemangioma, which, if necessary, should be carried out in the department of vascular or pediatric surgery. Depending on where the hemangioma is located, you may need to consult a pediatric gynecologist, urologist, otolaryngologist, ophthalmologist, maxillofacial surgeon, thoracic surgeon (he deals with the treatment of chest organs – lungs, heart, esophagus and others).
“The choice of a hemangioma treatment method depends on many factors,” says Grigory Somsikov, head of the vascular surgery department of the St. Vladimir Children’s City Clinical Hospital in Moscow, pediatric surgeon, specialist in pediatric vascular pathologies. – It is important to take into account the age of the child, the location of the hemangioma, its size, shape, growth trend. It is important to understand that it is in the first months of life that hemangiomas are most easily cured. First of all, formations that are on the face or in the anogenital region, joints and are growing rapidly are subject to early correction and complex treatment. As well as hemangiomas, which are prone to injury, ulceration.
In the arsenal of physicians today there are several ways to work with hemangiomas. Consider their features, as well as the pros and cons.
Local therapy with a beta-blocker. It is carried out with the drug Timolol (often in the form of a gel) and shows very good results. Thanks to its use, it is possible to stop the growth of hemangioma in newborns and achieve its involution (reverse development).
Treatment with a beta-blocker: ingestion. This method is used, as a rule, when a child has a large hemangioma, including ulcerations, or small formations, but having a critical localization, as well as combined and deep forms of hemangiomas.
Laser removal of hemangioma. A very effective, safe and bloodless method of removing hemangiomas. It is important to note that in the case of hemangiomas, a special type of laser is used – a pulsed dye laser. This is the only type of laser approved for use in the treatment of hemangiomas in young children. The laser gradually coagulates the vessels of the hemangioma, removes the layers of the tumor.
“He removes hemangiomas without skin damage, without bloodshed, after manipulations no crusts or scars form,” says Grigory Somsikov. – Laser treatment is provided free of charge under the compulsory medical insurance policy.
There are contraindications to the use of a laser: it is a malignant disease, photodermatitis, epilepsy, diabetes mellitus, infectious diseases.
Cryodestruction. This is not the method of choice for the treatment of hemangioma, however, it is also used in some clinics in Our Country. During cryodestruction, hemangioma is exposed to carbon dioxide or nitrogen. After that, a depression forms on the surface of the skin, over time it turns into a “crust”, then it disappears, an atrophic scar is formed. Therefore, the use of this method is possible only if the hemangioma is not located on the face, has a small size (no more than 2-2.5 mm) and there is no possibility to use other methods of treatment. It should be noted that in Europe and the USA, the method of cryodestruction in the treatment of infantile hemangiomas has not been used for a long time.
There are several other treatments that have been used in the past but are now considered unsafe and inappropriate. These include x-ray therapy, sclerotherapy (the introduction of drugs into the cavity of the tumor vessels), hormone therapy, and surgical removal of the formation. Due to serious side effects, these methods cannot be justified in the presence of more modern and safer methods for the treatment of hemangiomas.
When does it go away in newborns
As already noted, neonatal hemangioma has several phases of development. After the appearance in the first weeks of life, it actively grows. As a rule, the growth of education stops at 6-7 months. Then, for some time, the hemangioma is in an unchanged state, and after a year – one and a half years, the phase of involution begins, that is, the reverse development of the hemangioma. And over time, some of the formations pass. This usually happens by 5-10 years of age.
– The duration of the passage of a hemangioma depends on how much it has grown, where it is located, one formation may disappear after three years, the other after 7 years, – says Grigory Alexandrovich. “But it is important to understand that there are hemangiomas that go away easily and quickly and do not even leave any marks, and there are those that can leave a cosmetic defect that is not compatible with a comfortable social life. And no one can say how education will behave, how quickly and strongly it will grow at the initial stage, when the hemangioma has just appeared. Once again, I note that hemangioma is best treated in the first three months of life. But the decision on the need for treatment and correction of education is made in each case by the doctor and parents jointly, taking into account all possible risks and consequences.