Propranolol for the treatment of infantile hemangioma: Our experience at The Children’s Hospital, Lahore
DOI:
https://doi.org/10.66344/jpad.24.4.2014.219Keywords:
Infantile hemangioma, propranololAbstract
Objective To assess the effect of propranolol in growing infantile hemangioma (IH). Methods 122 children 68 girls and 54 boys, mean age 4.5 months, having IH were treated with oral propranolol. After taking baseline pulse, blood pressure, blood glucose level and echocardiography, propranolol was started at 0.5mg/kg body weight. Patients were monitored hourly for pulse, blood pressure and blood glucose level were noted and if no side effects noted for four hours, treatment was continued at home. Patients were reevaluated on day 10 and the dose was increased to 1.5-2 mg/kg daily in divided doses. Patients were followed up monthly for response and side effects. To avoid hypoglycemia in infants under the age of 3 months, mothers were advised to feed them every 2 hours. Results The earliest effect was change in color seen in all cases. Objective clinical evidence of softening and regression were seen after 2-3 weeks. Drug was given for mean period of 6.5 months. Overall clinical response was seen in 115 (94.3%) patients. It was graded as excellent (>75% improvement) in 92 (75.4%) and good (50-75% improvement) in 23 (18.9%) patients. Adverse effects during treatment were hypoglycemia 4 (3.3%), hypotension 3 (2.5%), cold extremities 2 (1.6%) and constipation 1 (0.8%). Relapse rate was none. Conclusion Propranolol given orally at 1.5-2.0 mg/kg/day has consistent, rapid therapeutic effect in shortening of natural course of IHs with good clinical safety.ÂReferences
Dickison P, Christou E, Wargon O. A prospective study of infantile hemangiomas with a focus on incidence and risk factors. Pediatr Dermatol. 2011;28:663-9.
Bauland CG, Luning TH, Smit JM et al. Untreated hemangiomas: growth pattern and residual lesions. Plast Reconstr Surg. 2011;127:1643-8.
Leaute-Labreze C, Dumas de la Roche E, Hubiche T et al. Propranolol for severe hemangiomas of infancy. N Engl J Med. 2008;358:2650-51.
Price CJ, Lattouf C, Baum B et al. Propranolol vs corticosteroids for infantile hemangiomas: a multicenter retrospective analysis. Arch Dermatol 2011; 147:1371–6.
Storch CH, Hoeger PH. Propranolol for infantile haemangiomas: insights into the molecular mechanisms of action. Br J Dermatol. 2010;163:269-74.
Drolet BA, Frommelt PC, Chamlin SL et al. Initiation and use of propranolol for infantile hemangioma: Report of a consensus conference. Pediatrics. 2013;131;128-40.
Luo Y, Zeng Y, Zhou B, Tang J. A Retrospective Study of Propranolol Therapy in 635 Infants with Infantile Hemangioma. Pediatr Dermatol. 2014. doi: 10.1111/pde.12308. [Epub ahead of print]
Sagi L, Zvulunov A, Lapidoth M, Ben Amitai D. Efficacy and safety of propranolol for the treatment of infantile hemangioma: a presentation of ninety-nine cases. Dermatology. 2014;228:136-44.
Andersen IG, Rechnitzer C, Charabi B. Effectiveness of propranolol for treatment of infantile haemangioma. Dan Med J. 2014;61:A4776.
Hermans DJJ, Bauland CG, Zweegers J et al. Propranolol in a case series of 174 patients with complicated infantile haemangioma. Br J Dermatol. 2013;168:837-43.
Lawley LP, Siegfried E, Todd JL. Propranolol treatment for hemangioma of infancy: risks and recommendations. Pediatr Dermatol. 2009;26:61614.
Aletaha M, Salour H, Bagheri A et al. Oral propranolol for treatment of pediatric capillary hemangiomas. J Ophthalmic Vis Res. 2012;7:130-3.
Zimmermann AP, Wiegand S, Werner JA, Eivazi B. Propranolol therapy for infantile haemangiomas: review of the literature. Int J Pediatr Otorhinolaryngol. 2010;74:338-42.
Hermans DJ, van Beynum IM, Schultze Kool LJ et al. Propranolol, a very promising treatment for ulceration in infantile hemangiomas: a study of 20 cases with matched historical controls. J Am Acad Dermatol. 2011;64:833-8.
Tan ST, Itinteang T, Leadbitter P. Low-dose propranolol for infantile haemangioma. J Plast Reconstr Aesthet Surg. 2011;64:292-9.
Denoyelle F. Role of propranolol in the therapeutic strategy of infantile laryngotracheal hemangioma. Int J Ped Otorhino. 2009;73:1168-72.
Love JN, Sikka N. Are 1–2 tablets dangerous? Beta-blocker exposure in toddlers. J Emerg Med. 2004;26:309-14.
Hussain T, Greenhalgh K, McLeod K. Hypoglycaemic syncope in children secondary to beta blockers. Arch Dis Child. 2009;94:968-9.
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