Hemangiomas in newborns
Hemangiomas in newborns are benign tumors formed by endothelial cells of blood vessels.More often they are localized on the skin, but can also appear in the muscle tissue and internal organs.
Note: in girls hemangiomas are diagnosed three times more often than boys.According to medical statistics, such neoplasms occur in about one in ten children.Table of contents: Causes of hemangiomas in newborns Hemangiomas Hemangioma diagnostics and treatment
Hemangiomas existence stages:
- active growth phase( 0-6 months);
- growth stop;
- involution( reverse development);
- complete biological regression( disappearance).
Infant hemangiomas occur due to intrauterine disruption of vascular formation.Immediately after birth or in the first 1-2 months of life, the skin of the baby reveals areas of thickening of pale or saturated burgundy color with uneven edges.They tend to increase gradually, especially in the first six months, and they can grow both in breadth and in depth.
In the second year of life, the growth of neoplasms consisting of normal and atypical endothelial cells is suspended, and the process of their involution begins.More than half of these vascular tumors disappear by five years, and by about 70%, about 70% disappear( in such cases, they speak of early involution). Hemangiomas are hormone-sensitive formations, and as a result, complete inhibition of growth can occur during puberty( late involution).
Causes of hemangiomas in newborns
A direct cause of development of tumors of this type has not yet been identified.
It is believed that predisposing factors are:
- borne by the future mother of respiratory viral infections in the first trimester of pregnancy( especially - at a period of 3-6 weeks, when the formation of the fetal cardiovascular system is underway);
- bad habits( smoking and alcohol consumption during pregnancy);
- Rh-conflict of mother and fetus;
- hormonal disorders;
- a woman's intake of some pharmacological drugs;
- adverse environmental conditions.
Probable causes include a rare stay of a pregnant woman in the open air.
There is an opinion that burdened heredity plays a certain role in the formation of infant hemangioma.
Specialists believe that the probability of hemangiomas in newborns increases many times in the following cases:
- during pregnancy was eclampsia( severe form of late toxicosis);
- pregnancy is multiple;
- to a woman at the time of delivery 38 years or more;
- baby was born prematurely or with low weight.
Types of hemangiomas
According to the accepted classification, hemangiomas are divided in structure and localization into three types of :
- Capillary( simple);
- combined( mixed).
Capillary hemangioma is always located in the outer layers of the dermis;It is a capillary of the dermis, intertwined with each other in the form of glomeruli.Such formations slightly rise above the surface of the skin and are characterized by small dimensions( usually not more than 1 cm in diameter).Tumors of this type rarely lead to the development of hemorrhages.The lower the color intensity, the better the forecast for complete spontaneous disappearance.
Cavernous tumors consist of vessels and cavities with venous or arterial blood.If they are localized in the outer layers of the skin, they are easily amenable to local treatment.Cavernous hemangiomas can also be detected in well-vascularized internal organs.
With the rupture of cavernous hemangiomas in the spleen, the risk of life-threatening profuse bleeding is great, since there are a huge number of blood vessels in this organ.
Very serious danger to the baby is represented by such formations in the liver.To detect them it is possible only casually or already at development of complications, t. To. A hemangioma exist absolutely asymptomatic. Against the backdrop of a minor mechanical trauma, a rupture of a cavernous vascular tumor is possible, which is accompanied by a massive hemorrhage into the abdominal cavity or inside the liver capsule.Unfortunately, more than 80% of babies are unable to save this complication.
Note: in premature babies, vascular neoplasms have the property of increasing in size 2-3 times faster than in children born on time.
One of the most insidious tumors is infant cavernous hemangioma, localized in the brain tissue.Despite its benign nature, it can cause a deep coma or death, because at the time of development, extensive subarachnoid or intracerebral hemorrhage develops.
Mixed hemangioma consists of capillary and cavernous fragments.During the diagnosis, it is often taken for a simple tumor.In the combined neoplasms invariably there are modified vessels of the nerve or connective tissue cells.
Important: Infant hemangiomas located in the area of the nose, ears, or on the oral mucosa are sometimes capable of causing problems with breathing, vision, or hearing.
Among the possible complications in addition to hemorrhages and organ dysfunction are thrombogenesis within the tumor .With large hemangiomas, active migration of platelets to their cavity leads to a relative deficiency of these blood cells.In young children, the syndrome Kazabaha-Merrita( combination of thrombocytopenia and deterioration of blood coagulation) develops.
If the tumor is localized in the area of the external genitalia or in areas of the skin that are often traumatized( for example, they are rubbed with clothing), its surface is often ulcerated.
Diagnosis and treatment of hemangioma
The choice of medical tactics is always directly dependent on objective research data.It is especially important to distinguish hemangiomas from angiomas and squamous cell carcinomas. At visual inspection, benign vascular tumors can often be confused with pyogenic granuloma and some types of nevi( moles).
Note: capillary hemangiomas can be detected even before the birth of the child during ultrasound( in particular with 3D ultrasound).Early diagnosis allows the timely outline of a plan of treatment.
There is a regularity: if more than 3 hemangiomas are detected on the skin of a child, then most likely they are on internal organs.
Basic treatment methods:
- surgical removal;
- Radiation therapy;
- systemic hormone therapy.
In the first month of life, the baby is never surgically treated with .If education does not grow and does not change in color, the main task of a specialist is to monitor the dynamics of the process.Removal is resorted to if the hemangioma of newborns tends to increase, affects the functions of internal organs or poses a threat to life( this applies to cavernous and mixed types of tumors).
Note: often does not have to take radical measures, as many hemangiomas( especially simple ones) disappear or become almost invisible during early and late involution.
Surgery is performed at the age of 3, 6 or 12 months.It involves partial or complete excision of hemangioma.The main indication for surgical treatment is the rapid growth of the tumor.Contraindications include the possibility of organ failure or a serious cosmetic defect after the intervention.
Important: indication of the operation may be significant neoplasm;In such cases, the extensive defect is closed with a donor flap of skin taken from another part of the patient's body.Children perform such operations very rarely.As a rule, blood transfusion is performed in parallel.
In most cases, doctors try to limit themselves to conservative treatment.At small( no more than 2.5 cm) tumors cryotherapy is widely used - local exposure to low temperatures. The hemangioma and surrounding healthy tissues( their capture is 0.5 cm) is covered with snow from frozen carbon dioxide.After the procedure, the site of the lesion is formed on the neoplasm site, which then swells.The resulting bubble becomes covered with a crust that disappears after 2 weeks.
Note: if the tumor grows deeper, then the cryodestruction is combined with microwave therapy.Initially, the affected area is exposed to high-frequency radiation, and then - to liquid nitrogen.
Sclerotherapy involves a local injection of urethane( quinine solution) and 70% ethanol( medical alcohol ).Aggressive composition causes clumping of the walls of the vessels( sclerosing), and in the place of hemangioma a connective tissue is formed.During the procedure, several injections are made to create an infiltrative roller at first along the circumference, and then in the center of the neoplasm.Manipulations are repeated as the edema disappears after previous injections( usually once a week).Sclerosing injections are resorted to when surgical treatment is impossible due to the specific localization of the tumor( oral mucosa, eyelids).
If the dimensions of the hemangioma do not exceed 5 mm in diameter, it is possible to eliminate it by electrocoagulation( cauterization). This technique is also used to remove fragments of neoplasm preserved after other procedures.Under the influence of electric current, the tissues that make up the basis of the hemangioma are denatured and die off.In their place a crust is formed, which soon disappears.
Radiotherapy is practiced if cavernous or mixed hemangiomas are diagnosed under the skin or in the tissues of the internal organs of the .Since radiation therapy negatively affects the body as a whole, it is never used to treat tumors in children under the age of six months.
Medication( systemic hormone therapy) involves the use of hormonal ointments( topically topically) or tablets( inside) of .Most often this method is used to eliminate hemangiomas, localized on internal organs.
Important: Infant hemangiomas never occur repeatedly, ie, relapse is completely excluded!
A child with benign vascular tumors should be supervised by a pediatric surgeon.
Vladimir Plisov, medical reviewer