Study designs of evaluations included in the review
Case series with at least five patients were eligible for inclusion, provided that there was sufficient information to determine the dose of corticosteroids and the response, and no patients were lost to follow-up. All of the included studies were retrospective case series. One case series that reported ultimate resolution of the haemangioma, and two case series in which it was not possible to determine the dose of corticosteroid, were excluded.
Specific interventions included in the review
Interventions that assessed systematic corticosteroids as the sole treatment were eligible, whereas regimens that included simultaneous treatment with other modalities were excluded. The different corticosteroid regimens were converted into a prednisone equivalent daily dose (mg/kg), based on the corticosteroid dose used. The mean prednisone equivalent daily dose was 2.9 mg/kg (95% confidence interval, CI: 2.7, 3.1), given orally for a mean of 1.8 months (95% CI: 1.5, 2.2; range: 0.5 to 5.4 months) before any tapering of the dose.
Participants included in the review
The inclusion criteria stipulated patients with enlarging, problematic cutaneous haemangiomas. Patients were excluded on the basis of the following exclusion criteria: age older than 2 years; lymphangiomas, cystic hygromas, and arteriovenous malformations; Kasabach-Merritt syndrome; liver, subglottic, parotid, laryngeal, or gastrointestinal tract haemangiomas; stable or involuting haemangiomas. The mean age of the infants upon initiation of the therapy was 4.5 months (95% CI: 3.8, 5.2).
Outcomes assessed in the review
The inclusion criteria were not defined a priori in terms of the outcomes. The following outcomes were assessed in the review: response; time to response; whether rebound occurred; and adverse effects. Response was defined as the cessation of growth of a previously growing haemangioma, or a reduction in size of the haemangioma coincident with initiation of systematic steroid therapy. Rebound was defined as an increased growth of a haemangioma after corticosteroid treatment was ceased or reduced.
How were decisions on the relevance of primary studies made?
The titles and the abstracts of the identified studies were reviewed according to the inclusion, and then the exclusion criteria.
The authors do not state how many of the reviewers performed the selection.