Propranolol treatment for infantile hemangioma: a case series of sixty-two patients

Abstract

Infantile hemangiomas (IH) complicated by ulceration, disfigurement, functional impairment or life-threatening conditions need early, safe and effective treatment. This study explores the impact of propranolol on complicated IH. We report our experience of 62 patients treated with oral propranolol for complicated IH. The effect of propranolol was assessed using a score on a visual analogue scale integrated with echo, magnetic resonance or endoscopic findings. The average age at the beginning of the treatment was seven months [standard deviation (SD)±8.9], with a median of four months (range 1-53 months). The average age at the end of the treatment was 15 months (SD±8.4), with a median of 13 months (range 7-59 months). The mean treatment length was eight months (SD±3.2). Oral propranolol was successful in 95.2% of the patients in reducing the volume, the intensity of color and the elevation of IH. Statistically significant improvement of IH volume was observed in the first two months of therapy (P≤0.001), and between the second month and the end of the treatment (P<0.05). No significant bradycardia or hypotension occurred. Severe hypoglycemia occurred in one patient. Mild adverse effects were observed in seven patients. Our study demonstrates that propranolol administered orally at 2 to 3 mg/kg/day has a rapid therapeutic effect leading to remarkable shortening of the natural course of IH and it is safe in the majority of patients.

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.…”

“…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. 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.…”

The effectiveness and safety of topical β‐receptor blocker in treating superficial infantile haemangiomas: A meta‐analysis including 20 studies

“…2,4,5 While controversy still exists concerning the safety of systemic propranolol as there have been some studies reporting the occurrence of such severe adverse effects as bronchial asthma, hypotension, hyperkalaemia and hypoglycaemia. [6][7][8] A few reports have demonstrated that topical propranolol or topical timolol provides an effective and safe alternative to oral propranolol in the treatment of SIH. In the 2015 recommendations made by an European expert group, it was stated that topical β-blockers have the potential to become the first-line treatment for superficial and small haemangiomas.…”

“…There has been increasing research supporting oral propranolol as a first‐line treatment for infant haemangiomas, which ensures effectiveness treatment with a wide margin of safety . While controversy still exists concerning the safety of systemic propranolol as there have been some studies reporting the occurrence of such severe adverse effects as bronchial asthma, hypotension, hyperkalaemia and hypoglycaemia . A few reports have demonstrated that topical propranolol or topical timolol provides an effective and safe alternative to oral propranolol in the treatment of SIH.…”