Efficacy and safety of propranolol as first-line treatment for infantile hemangiomas

Division of Plastic Surgery, University Children's Hospital Zurich, Zurich, Switzerland.
European Journal of Pediatrics (Impact Factor: 1.98). 10/2010; 170(4):493-501. DOI: 10.1007/s00431-010-1324-2
Source: PubMed

ABSTRACT Beta-blockers are a highly promising treatment modality for complicated infantile hemangiomas (IH). However, data on propranolol as first-line treatment, objective outcome measures and impact on hemodynamics in young infants is limited. We retrospectively evaluated a homogenous group of infants with proliferating complicated IH treated with propranolol (2 mg/kg/day). Outcome was assessed by blinded evaluation of clinical photographs by visual analogue scale (VAS), ultrasound examination and ophthalmological review (if appropriate). Tolerance and hemodynamic variables were recorded over time, including a 2-day in-patient observation at the initiation of therapy. Twenty-five infants (median age 3.6 (1.5-9.1) months) were included in the study. The median follow-up-time was 14 (9-20) months and 14 patients completed treatment at a median age of 14.3 (11.4-22.1) months, after a duration of 10.5 (7.5-16) months. In all patients, there was significant fading of colour (with a VAS of -9 (-6 to -9) after 7 months) and significant decrease in size of the IH (with a VAS of -8 (-3 to -10) after 7 months). Median thickness of the lesions assessed by ultrasound at baseline and after 1 month was 14 (7-28) mm and 10 (5-23) mm, respectively (p < 0.01). In children with periocular involvement, astigmatism and amblyopia resolved rapidly within 8 weeks. The overall tolerance of propranolol was good, and no relevant hemodynamic changes were noted. CONCLUSION: Our report supports the excellent effect and good tolerance of this novel therapy, and we propose the use of propranolol as first-line treatment for IH.

1 Follower
  • [Show abstract] [Hide abstract]
    ABSTRACT: This study was aimed at assessing the efficacy of propranolol treatment in infantile hemangiomas (IHs) by ultrasound. Thirty-one patients with IHs were administered propranolol and were assessed by ultrasound before treatment, 3 mo after treatment and at the end of treatment. Longitudinal and transverse diameters, as well as thickness of hemangiomas measured by clinical observation differed significantly (p < 0.05) from measurements obtained by ultrasound. Ultrasound also revealed that longitudinal and transverse diameters, thickness, vascular density, blood flow velocity (arterial and venous) and arterial peak systolic blood flow velocity of hemangiomas were significantly decreased (p < 0.05) after treatment compared with before treatment. The resistive index and systolic/diastolic blood flow velocity in IHs were significantly higher (p < 0.05) after treatment than before treatment. In conclusion, ultrasound can evaluate the efficacy of propranolol at the termination of therapy.
    Ultrasound in Medicine & Biology 09/2014; 40(11). DOI:10.1016/j.ultrasmedbio.2014.06.021 · 2.10 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We describe the successful treatment of an infant with life-threatening Kasabach–Merritt syndrome (KMS) who received propranolol therapy. A full-term, 6-week-old female infant, in poor general condition, was admitted with a large vascular tumor of right buttock, perineal region, extending to a lumbar region and the right thigh. There was a gray-blue, tense, shiny, warm swelling over the site of vascular tumor. The child had platelet count of 20,000 cells/mm. d-dimer was positive and suggestive of consumptive coagulopathy. A diagnosis of KMS was made. Computer tomography (CT) imaging was suggestive of a vascular tumor – Kaposiform hemangioendothelioma. The baby was initially treated with platelet, fresh frozen plasma and blood transfusions. There was temporary rise in platelets to 118,000 cells/mm but after transfusions the platelets dropped to 20,000 cells/mm and the baby developed purpuric swelling over right thigh and right buttock. Platelet transfusions were discontinued and propranolol treatment was started. From the 4th day, the swelling started regressing and the platelet count rose to 73,000 cells/mm. At the age of 2 years, the tumor has nearly completely involuted. In our case propranolol proved to be effective first-line treatment for Kasabach–Merritt syndrome associated with a vascular tumor – Kaposiform hemangioendothelioma. Minor side effect was poor weight gain after prolonged treatment.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Infantile hemangiomas (IH) are neoplastic proliferations of endothelial cells which occur with an incidence of 10 to 12% within the first year of life. IH grow after birth and usually regress spontaneously, but still can lead to deformities when they are located in the facial areas of the lip, eyelid, nasal tip or the ear. We wanted to share our experience in the treatment of problematic IH with propranolol. A retrospective review of medical charts was performed for 40 consecutive children treated with propranolol because of problematic IH between 2009 and 2012. 40 patients (33 girls, 7 boys) with a median age of 4.2 months (aged 1 to 11 months) were treated because of problematic IH. Rapid improvement was reported in the first days of treatment in 38 patients. In one case we had to terminate the treatment because serious tachycardia developed within the first 48 hours after propranolol was started. In this case the patient benefited from alternative treatment with timolol maleate gel. 35 patients (87%) showed an excellent response with complete resolution of the lesion. 4 patients (10%) showed a good result with >50% reduction in the size of the hemangioma. Also a patient with residual IH after terminating oral propranolol benefited from topical treatment with timolol maleate gel. A minor side effect was poor weight gain during prolonged treatment in one patient and tachycardia in another patient in which case we had to terminate the treatment.
    Postępy Higieny i Medycyny Doświadczalnej (Advances in Hygiene and Experimental Medicine) 01/2014; 68:1138-44. DOI:10.5604/17322693.1120990 · 0.63 Impact Factor