Schiestl C, Neuhaus K, Zoller S, et al.. 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: 1.89).
10/2010; 170(4):493-501. DOI: 10.1007/s00431-010-1324-2
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.
Available from: Ewa Matuszczak
- "Supportive therapies include FFP and platelet transfusions. Patients with high-output cardiac failure need management to avoid further cardiac compromise      . "
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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.
Our observations show that gradually increasing the dosage of propranolol up to 3 mg/kg and gradually weaning the dosage is safe and effective in treatment of problematic IH. Timolol maleate gel should be considered as a complementary treatment for residual hemangiomas after terminating propranolol treatment or as an alternative treatment in patients who do not tolerate oral propranolol well.
Available from: Wojciech Debek
- "Vascular tumors in the pediatric age group e usually are infantile hemangiomas (IH) e common, benign tumors, occurring in 4e10% of infants . A significant proportion of vascular tumors are associated with substantial morbidity in infancy and childhood . "
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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.
Available from: sciencedirect.com
- "If the IHH is asymptomatic, expectant management can safely be adopted. In symptomatic cases (i.e., KasabacheMerritt syndrome) medical, radiologic, or surgical treatment is indicated  "
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ABSTRACT: Beckwith–Wiedemann syndrome (BWS) predisposes to embryonic tumors. The concomitant presence of pathologically different tumors requires patient-specific surgical care. We report a case of simultaneous occurrence of a hepatoblastoma (HB) and an infantile hepatic hemangioma (IHH). A 4-month-old girl with BWS presented with two liver masses (one in segment VI/V and the other in segment VII). Biopsy of the larger lesion confirmed the diagnosis of HB. Standard chemotherapy was started and a right hepatectomy was planned. The two masses reacted differently to chemotherapy, with a marked decrease in the size of the larger tumor, and no change in the size of the smaller one. Thus, after four chemotherapy cycles, enucleation of the smaller of the two masses was performed and intraoperative examination of the specimen revealed the presence of an IHH. Segmentectomy of the second, larger tumor was then performed, instead of the originally planned right hepatectomy. The presence of both HB and IHH in children with BWS is rare. Early recognition of the two different tumors allows for patient-specific surgical care, with resection of less liver tissue. This is important in children with BWS given the persistent lifelong risk for additional liver tumors requiring liver resections.
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