Limited utility of repeated vital sign monitoring during initiation of oral propranolol for complicated infantile hemangioma

Püttgen, Katherine B.; Hansen, Leanna M.; Lauren, Christine T.; Stefanko, Nicole; Mathes, Erin F.; Olsen, Gerilyn M.; Tollefson, Megha M.; Adams, Denise M.; Baselga, Eulàlia; Chamlin, Sarah L.; Corey, Kristen; Frascari, Flora F.; Frieden, Ilona J.; Galligan, Eloise R.; Gupta, Deepti; Haggstrom, Anita N.; Horii, Kimberly A.; Hornik, Christoph P.; Klajn, Justyna; Liberman, Leonardo; Mancini, Anthony J.; Mannschreck, Diana; McGinness, Anelah; McCuaig, Catherine; Newell, Brandon; Nguyen, Henry; Nopper, Amy J.; Oyesanya, Tola; Powell, Julie; Reynolds, Megan; Ríos, Mónica; Siegel, Dawn H.; Ward, Kendra; Garzon, María C.; Frommelt, Peter C.; Drolet, Beth A.

doi:10.1016/j.jaad.2020.04.013

Cited by 18 publications

(30 citation statements)

References 21 publications

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“…This female predominance in our study matches the demographics reported in the literature. 9,12,13 Though there were clinically significant drops in HR and SBP measured, no patients experienced symptomatic hemodynamic changes following dose initiation or escalation. There were no cardiac related adverse events reported by any patient families.…”

Section: Discussionmentioning

confidence: 94%

“…Current consensus amongst practicing providers on monitoring is still up for debate. 1,8 Our study was prompted both by recent publications suggesting less monitoring 9,12 as well as the authors' recent experience with initiating and managing propranolol treatment of IH over teledermatology amidst the COVID-19 pandemic. No significant differences in immediate or future adverse events were detected comparing Protocols 1 and 2 at our institution.…”

Section: Discussionmentioning

confidence: 99%

“…8 Most recently, a large multicenter study evaluating 783 patients was published supporting less monitoring in the setting of thorough prescreening. 9 Currently at our institution, initiation of propranolol for IH follows one of three protocols. Traditionally, treatment begins with a comprehensive outpatient visit involving the administration of the starting dose followed by two hours of observation.…”

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confidence: 99%

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Is prolonged monitoring necessary? An updated approach to infantile hemangioma treatment with oral propranolol

Johansen

Mahendran

Lawley

2021

Pediatric Dermatology

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Infantile hemangiomas (IH) are the most common soft-tissue tumors in childhood, occurring in up to 10% of infants. 1,2 The majority of these benign vascular tumors require no treatment; however, in at least 12% of patients, they can become problematic, and depending on their anatomic location and extent of growth, require clinical evaluation and treatment. 1,3,4 In these cases, oral propranolol has emerged as a first-line treatment. 5 While the efficacy of propranolol as a treatment has been well supported through many studies, substantial variability in administration protocols remains. 2 Current FDA prescribing information for Hemangeol™ and provisional consensus guidelines recommend monitoring heart rate (HR) and blood pressure (BP) after the first and second hours following propranolol initiation and after each dose increase. 1,6,7 However, actual initiation and titration practices differ among providers and

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Is prolonged monitoring necessary? An updated approach to infantile hemangioma treatment with oral propranolol

Johansen

Mahendran

Lawley

2021

Pediatric Dermatology

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“…Topical timolol has been widely used for treating IH with efficacy reported, particularly for small, superficial IH. 9,15 Systemic absorption is variable but does occur, 17,18 suggesting that similar prescreening should be performed to assure that infants are healthy and have had a normal cardiovascular and pulmonary examinations, for example, via recent history and physical examination (see discussion below).…”

Section: Other Orally Administered Beta-blockers and Topical Beta-bmentioning

confidence: 99%

Management of infantile hemangiomas during the COVID pandemic

Frieden

Püttgen

Drolet

et al. 2020

Pediatric Dermatology

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The COVID-19 pandemic has caused significant shifts in patient care including a steep decline in ambulatory visits and a marked increase in the use of telemedicine. Infantile hemangiomas (IH) can require urgent evaluation and risk stratification to determine which infants need treatment and which can be managed with continued observation. For those requiring treatment, prompt initiation decreases morbidity and improves long-term outcomes. The Hemangioma Investigator Group has created consensus recommendations for management of IH via telemedicine. FDA/EMAapproved monitoring guidelines, clinical practice guidelines, and relevant, up-to-date Pediatric Dermatology FRIEDEN Et al.

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“… 37 , 49 , 58 , 59 A recent study in 2020 found that in-office vital monitoring is unlikely to be useful in infants older than 5-week gestational corrected age with normal birth weight. 60 …”

Section: Reviewmentioning

confidence: 99%

Paediatrics: how to manage infantile haemangioma

Kim¹,

Lam²

2021

DIC

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Infantile haemangiomas (IHs) are relatively common benign vascular tumours found in the paediatric population. They have varying sizes and involve different depths in the skin leading to various colours, shapes and textures. Although considered harmless in most cases, they may lead to life-threatening complications or cause permanent disfigurations and organ dysfunction. For problematic IHs, the treatment options include oral and topical beta-blockers, systemic corticosteroids, laser treatment, and surgery. In this narrative review, the treatment options for problematic IH are compared and delivered concisely to facilitate the clinical decisions from practitioners, including those in primary care settings. Oral propranolol is currently considered the first-line intervention for problematic IHs. For superficial lesions, there is robust evidence for the use of topical timolol maleate. Systemic corticosteroids are sometimes used in specific situations such as resistance or contraindications to beta-blockers. Surgical excision can be considered in cases requiring urgent intervention such as airway obstruction; this can be done alongside laser therapies for the removal of residual tissue or when reconstructing areas of deformity. The combination of multiple treatment modalities may lead to a more rapid clinical response.

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Limited utility of repeated vital sign monitoring during initiation of oral propranolol for complicated infantile hemangioma

Cited by 18 publications

References 21 publications

Is prolonged monitoring necessary? An updated approach to infantile hemangioma treatment with oral propranolol

Is prolonged monitoring necessary? An updated approach to infantile hemangioma treatment with oral propranolol

Management of infantile hemangiomas during the COVID pandemic

Paediatrics: how to manage infantile haemangioma

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