Predicting complications with pretreatment testing in infantile haemangioma treated with oral propranolol

Abstract

The predictive values of both protocols for the commonly observed adverse reactions are low. In this series, there is no evidence to suggest that routine pretreatment testing before propranolol initiation is of any value in otherwise healthy children.

Clinical Practice Guideline for the Management of Infantile Hemangiomas

“…Sleep disturbance, sleeping disorders, agitation during the night, and nightmares or night terrors were mentioned in 6 of 8 reports and occurred in 2% to 18.5% of patients who were treated. 80,82,85,86,89,90 In 3 of these 6 reports, propranolol treatment was modified (reduction in dosage, earlier-evening dosing, and early discontinuation of therapy) in response to these effects. 80,82,85 In 4 reports, possible respiratory adverse effects were mentioned, including labored breathing in 0.9%, 86 breathing-related problems in 11.5%, 89 respiratory disorders in 3.4%, 80 and wheezing or bronchiolitis in 12.9%.…”

“…80,82,85,86,89,90 In 3 of these 6 reports, propranolol treatment was modified (reduction in dosage, earlier-evening dosing, and early discontinuation of therapy) in response to these effects. 80,82,85 In 4 reports, possible respiratory adverse effects were mentioned, including labored breathing in 0.9%, 86 breathing-related problems in 11.5%, 89 respiratory disorders in 3.4%, 80 and wheezing or bronchiolitis in 12.9%. 82 In 3 of these series treatment modifications in response to the respiratory events were mentioned, including temporary discontinuation of therapy 80,82 and decreased dosage of propranolol.…”

“…82 In 3 of these series treatment modifications in response to the respiratory events were mentioned, including temporary discontinuation of therapy 80,82 and decreased dosage of propranolol. 89 Although bradycardia and hypotension are known to accompany propranolol-associated β-receptor blockade, both tend to be mild and asymptomatic in children treated for IHs who have no preexisting cardiac comorbidities. 3, 84, 87, 88, 91 -93 In the subcommittee's review, only 1 of the 8 reports mentioned hypotension or bradycardia as an adverse event, with 1 of 906 patients (0.1%) exhibiting bradycardia and 2 of 906 exhibiting asymptomatic hypotension.…”

Cost-effectiveness of treating infantile haemangioma with propranolol in an outpatient setting

“…Some studies have advocated an indication-driven approach to pretreatment testing with echocardiograms performed if suggested by a thorough history and physical examination. 14,17 Those cost comparisons with and without the use of an echocardiogram are displayed in Table 2.…”

“…However, routine pretreatment echocardiogram has not shown any benefits in otherwise healthy children. 14 In this review, we sought to compare the cost-effectiveness of initiating treatment with propranolol in an inpatient versus outpatient setting, and objectively observe the expenditures involved in these two alternative pathways. We also included the effect on expenditure when a pretreatment echocardiogram was performed for both pathways.…”