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Steroids for Hemangiomas Don't Jeopardize Height


 

CHICAGO — Short-term treatment with oral corticosteroids doesn't appear to prevent infants with hemangiomas from achieving normal height, based on data from a study of 44 children with infant hemangiomas who were treated with corticosteroids for an average of 14 months.

All but two children (95%) had grown to within two standard deviations of their predicted normal heights by the time they were approximately 5 years old. The predicted normal heights were based on the average midparental height, which is a formula for predicting a child's normal adult height based on the heights of both parents. For the general population, the expected future height falls within two standard deviations of the midparental height.

"Our research question was whether short-term corticosteroids impacted long-term growth," said Dr. Perla Lansang, who presented the findings at the annual meeting of the Society for Pediatric Dermatology.

The efficacy of treating large infant hemangiomas with oral corticosteroids has been well documented, but short-term growth retardation is a common side effect and the potential for long-term growth retardation remains a concern, said Dr. Lansang, a dermatologist who conducted the study at the Hospital for Sick Children, Toronto, as part of a resident research award from the society.

The study population included 8 boys and 36 girls with hemangiomas who were treated with oral corticosteroids at the hospital between January 2000 and December 2005. Children with other metabolic conditions or those who were taking corticosteroids for other reasons were excluded. The children started taking oral corticosteroids at an average of 3 months of age, and the average dosage was 2.2 mg/kg per day. Although all the children experienced growth retardation while taking the steroids, the steepest drop off the growth curve occurred primarily during the first 3 to 4 months of treatment, Dr. Lansang noted.

The children's growth resumed after an average of 8 months of treatment, but the most rapid increase in catch-up growth occurred during the first 2 years after the children stopped taking corticosteroids. The mechanism of action for growth velocity patterns after the discontinuation of steroid use is not well understood, but by the end of the study most of the children were on track to achieve their normal height based on midparental height, Dr. Lansang said. The findings may ease clinicians' and parents' concerns about long-term growth outcomes for these children.

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