Deep coma in a child treated with propranolol for infantile hemangioma

Bakalli, Ilirjana; Kola, Ermira; Lluka, Robert; Celaj, Ermela; Sala, Durim; Gjeta, Inva; Sallabanda, Sashenka; Klironomi, Dea

doi:10.1186/s12887-019-1598-0

Cited by 13 publications

(16 citation statements)

References 22 publications

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“…We are aware of an infant in our own institution who required cardiopulmonary resuscitation during an episode of bronchial disease while on oral propranolol treatment. Other reports of severe adverse reactions to propranolol include hypoglycaemic coma and fatal hyperkalaemia during general anaesthesia [15,16]. Therefore, it is recommended that infants on systemic propranolol are closely monitored and that parents are counselled to discontinue propanolol during times of poor feeding and respiratory illness and to make the anaesthetist aware of the propanolol treatment [4].…”

Section: Discussionmentioning

confidence: 99%

Topical Timolol for Infantile Haemangioma of the Orbit

Hildebrand

Sipkova

2021

Klin Monbl Augenheilkd

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Infantile haemangiomas (IHs) are the most common benign tumours of the eyelid and orbits in infancy. Beta-blockers, in the form of oral propranolol, have become first-line treatment in severe cases with functionally significant or disfiguring IH. However, adverse drug reactions of oral propranolol in infants are reported in 1 in 11 and serious or potentially life-threatening systemic side effects in 1 in 38, including dyspnoea, hypotension, hyperkalaemia, hypoglycaemia, and cyanosis, therefore requiring careful and close monitoring during the course of systemic treatment. More recently, two large meta-analyses have shown topical beta-blockers, such as timolol maleate 0.5%, to be as effective as oral propranolol in superficial IH, but with no or significantly fewer adverse effects, and have advocated that topical beta-blockers replace oral propranolol as the first-line treatment of superficial IH. We have previously reported the therapeutic response of deep periocular IH to primary topical timolol maleate 0.5% monotherapy. Here we also describe the first successful treatments of large orbital IHs with primary topical timolol maleate 0.5% monotherapy in four infants, resulting in immediate cessation of progression and rapid clinical improvement or resolution in all cases. No adverse effects and no recurrence during long-term follow-up of up to 2.5 years after cessation were seen in any of the patients treated with topical timolol maleate 0.5%.

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Section: Discussionmentioning

confidence: 99%

Topical Timolol for Infantile Haemangioma of the Orbit

Hildebrand

Sipkova

2021

Klin Monbl Augenheilkd

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“…Meanwhile, some dermatologists remain reluctant to use propranolol due to potential serious adverse effects in young patients. 7 Studies revealed that the efficacy rate of propranolol was greater than that of corticosteroids in treating IH. Additionally, propranolol had fewer complications than steroids.…”

Section: Discussionmentioning

confidence: 99%

Infantile Hemangioma Treated with Oral Propranolol: Case Presentation

Raufi

Nemat

2021

CCID

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Infantile hemangiomas (IHs) are the most common vascular tumors in childhood. We report the use of propranolol to treat the growth phase of IHs. Propranolol was given to a 6-month-old infant who presented with a 4-cm sharply demarcated hemangioma on his left gluteal region. After relevant evaluation, propranolol was prescribed with a starting dose of 1 mg/kg/day, given in 3 divided doses. Vital signs were monitored during the first 6 hours of treatment. In the absence of side effects, treatment was continued at home with 2 mg/kg/day for six months, and the child was reevaluated after 7 days of treatment and then monthly. After one month, effects on color and growth were noted. Complete healing occurred in less than 6 months. Side effects and relapse were not reported. Propranolol administered orally at 2 mg/kg/day was successful, leading to near resolution of the patient’s hemangioma.

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“…Six of 35 infants (17.1%) who were treated with oral propranolol underwent retinopathy of prematurity intervention, as opposed to 14 of 36 (38.9%) control infants [21]. An 18 month old boy presented caries in the upper central incisors following the use of propranolol solution for the treatment of an infantile haemangioma [22].…”

Section: Adverse-effects Caused By Propranolol In Infants and Childrenmentioning

confidence: 99%

Clinical Pharmacology of Propranolol in Infants and Children

Pacifici¹

2021

JCLR

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Propranolol is α nonselective β adrenergic receptor antagonist with equal affinity for β1 and β2 adrenergic receptors, lacks intrinsic sympathomimetic activity, and does not block α receptors. Propranolol is absorbed following oral administration and consists in two enantiomers, the (-) enantiomer is the active form and is cleared from the body more slowly than the inactive (+) enantiomer. Much of propranolol is metabolized in the liver and the metabolites of propranolol are 4-hydroxypropranolol, 5-hydroxypropanolol, N-desisopropranol, and propranolol β-D-glucuronide. The oral dose of propranolol hydrochloride is 250 to 750 µg/kg thrice-daily in infants and in children it is 200 to 500 µg/kg thrice-daily or 4 times-daily. Propranolol has been found efficacy and safe in infants and children but may induce adverse-effects. The elimination half-life of propranolol is about 15 hours in term and preterm infants and the distribution volume of propranolol is larger than the water volume. Propranolol interacts with drugs. Halofenate, phenytoin, phenobarbitone, rifampicin, and ethanol which affect the clearance of propranolol, and chlorpromazine and cimetidine inhibit the metabolism of propranolol. The prophylaxis, treatment, and trials with propranolol have been extensively studied in infants and children. Propranolol crosses the human placenta but it does not equilibrate between the maternal and foetal compartment and migrates into the beast-milk. The aim of this study is to review the published of propranolol dosing, efficacy and safety, effects, adverse-effects, metabolism, pharmacokinetics, interaction with drugs, prophylaxis, treatment and trials in infants and children and propranolol transfer across the human placenta and migration into the beast-milk.

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Deep coma in a child treated with propranolol for infantile hemangioma

Cited by 13 publications

References 22 publications

Topical Timolol for Infantile Haemangioma of the Orbit

Topical Timolol for Infantile Haemangioma of the Orbit

Infantile Hemangioma Treated with Oral Propranolol: Case Presentation

Clinical Pharmacology of Propranolol in Infants and Children

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