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A random-effects consistency model was fitted using the BUGSnet package. Evidence certainty was assessed using the CINeMA framework, and risk of bias was evaluated using the revised Cochrane RoB 2 tool.\u00a0Thirty randomized controlled trials (RCTs) including 2,639 patients across nine treatment nodes were included in the efficacy analysis, and 12 RCTs involving 1,143 patients across eight nodes were included in the safety analysis. Using oral propranolol as the reference treatment, no active intervention demonstrated statistically significant superiority in efficacy, whereas placebo was significantly inferior. Corticosteroids were the only intervention associated with substantially higher adverse event rates, whereas atenolol showed a trend toward fewer adverse events.\u00a0By anchoring all comparisons to oral propranolol and integrating CINeMA certainty assessments with inconsistency testing, these findings are consistent with the continued role of oral propranolol as the reference systemic treatment for infantile hemangioma. For patients intolerant to propranolol, atenolol may represent a reasonable alternative.<\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusions<\/jats:italic>\n                    :\u00a0By anchoring all comparisons to oral propranolol and integrating CINeMA certainty assessments with inconsistency testing, these findings are consistent with the continued role of oral propranolol as the reference systemic treatment for infantile hemangioma. For patients intolerant to propranolol, atenolol may represent a reasonable alternative.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Oral propranolol is the established first-line systemic therapy for infantile hemangioma.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Previous network meta-analyses have reported treatment rankings, but the clinical meaning of these rankings relative to oral propranolol remains uncertain.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Despite favorable point estimates for combination therapy and nadolol, this benchmark-anchored analysis found no included active intervention statistically superior to oral propranolol.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Certainty assessment showed that treatment rankings were limited by heterogeneity, inconsistency, risk of bias, and imprecision; atenolol had the largest body of direct comparative evidence among the alternatives.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-026-07257-y","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T12:40:40Z","timestamp":1784637640000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Efficacy and safety of interventions for infantile hemangioma compared with oral propranolol: an updated systematic review and bayesian network meta-analysis"],"prefix":"10.1007","volume":"185","author":[{"given":"Caihong","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liehao","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lingfeng","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"7257_CR1","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1111\/bjd.12804","volume":"170","author":"A Munden","year":"2014","unstructured":"Munden A, Butschek R, Tom WL, Marshall JS, Poeltler DM, Krohne SE et al (2014) Prospective study of infantile haemangiomas: incidence, clinical characteristics and association with placental anomalies. 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