# Comparative efficacy of urea, bleomycin, and polidocanol for infantile hemangioma: a retrospective cohort study with ultrasound correlation ultrasound characteristics of infantile hemangioma

## TL;DR

This study compares three treatments for infantile hemangiomas and finds bleomycin to be the most effective, with ultrasound blood flow measurements predicting treatment success.

## Contribution

The study provides a novel comparison of urea, bleomycin, and polidocanol for infantile hemangioma treatment and identifies ultrasound blood flow grade as a predictor of outcomes.

## Key findings

- Bleomycin showed the highest complete response rate (40%) at 6 months with no non-responsive cases.
- Ultrasound-measured reduction in blood flow grade strongly correlated with better treatment outcomes (p < 0.05).

## Abstract

To compare the efficacy of urea, bleomycin, and polidocanol in treating infantile hemangiomas (IHs) and evaluate correlations between ultrasound features and treatment outcomes.

This retrospective cohort study analyzed 234 IHs cases treated with urea (Group A), bleomycin (Group B), or polidocanol (Group C) between January 2020 and January 2025. Infants aged 0–3 years received two sclerotherapy courses spaced 4 months apart. Outcomes were assessed via clinical measurements, ultrasound evaluations (blood flow grade, vascular proliferation), and physician assessments. Safety and adverse events were also monitored.

Bleomycin demonstrated superior efficacy, with a 40% complete response (CR) rate at 6 months and no non-responsive cases. Urea showed gradual improvement over time (33% CR at 6 months), while polidocanol had variable efficacy (25% CR at 6 months). Reduction in ultrasound-measured blood flow grade strongly correlated with better outcomes (p < 0.05), but vascular proliferation changes (mesh-like texture) showed no clear association. No significant adverse events were reported during the study period.

Bleomycin is the most effective and stable sclerotherapy for IHs, particularly for rapid response. Urea may suit long-term management, while polidocanol requires cautious use. The reduction in blood flow grade, as assessed by ultrasound, is a significant predictor of better therapeutic outcomes. These findings suggest that monitoring blood flow grade through ultrasound could serve as a valuable tool for clinicians to evaluate the efficacy of sclerotherapy in real-time. As a retrospective study, these findings should be interpreted with consideration of potential selection bias. Further prospective studies are needed to validate results and optimize protocols. The study design is retrospective, which introduces potential biases such as selection bias and confounding variables. The conclusions drawn from this study should be interpreted with caution due to these limitations. Future research should include prospective, randomized controlled trials to validate the findings and minimize biases.