ROLE AND SAFETY OF ORAL PROPRANOLOL IN INFANTILE HAEMANGIOMAS

Main Article Content

Dr Dipesh Goel
Dr Gaurav Singal
Dr Prateek Sharda

Keywords

Infantile haemangiomas (IHs), Propranolol

Abstract

Background and objectives Infantile haemangiomas (IHs) are the most common benign vascular tumors seen in neonatal period. Some presents with life-threatening complications, functional impairment, ulceration and disfigurement requiring intervention. Oral propranolol is the first line treatment for the IHs in these high-risk group. It reduces the size of lesion by inducing vasoconstriction, decreasing vascular endothelial growth factor (VEGF), induction of endothelial cell apoptosis, inhibition of nitric oxide production, and suppression of the renin-angiotensin system. Propranolol is contraindicated in children with bronchial asthma, hypoglycaemia, heart blocks and hypersensitivity to propranolol. Some non-serious side effects are sleep disturbances, irritability, diarrhoea and lethargy, thus requiring dose titration. So, to determine the effectiveness and safety of oral propranolol therapy in IHs a study is proposed.


Methodology A retrospective study was conducted from May 2022 to October 2023. Inclusion and exclusion criteria were applied, n = 21. Oral propranolol was stared at the dose of 1mg/kg/day after obtaining baseline heart rate (HR), blood pressure (BP), ECG and 2DECHO on OPD basis. The dose was then increased gradually (0.5mg/kg/day in each visit) to maximum of 3 mg/kg/day given in divided doses. Serial clinical examination (HR & BP), ECG and 2DECHO was done prior to increase the dose. These were also repeated in case development of adverse effects to propranolol therapy. Intolerable adverse effects were treated by dose titration. Oral propranolol therapy was continued for complete 1 year after initiating it.


Results IHs were commonly seen in females (71%) vs male (29%). The most common site of IHs was head, neck and face region (HNF – 57.1%).  This was followed by trunk (28.6%) and limbs (14.3%). There was decrease in tenseness and brightness of the lesion in all children. There was decrease in longest length of the IHs lesion by 72.95% after 12 months of oral propranolol therapy (P< 0.0001) at the dose of 2.6mg/kg/day. Dizziness was the most common side effect seen which can be managed by dose titration.


Conclusions Oral propranolol therapy is the first line, safe and effective treatment in Infantile haemangiomas. There are no major side effects of the therapy and it can be given safely in OPD settings.

Abstract 117 | pdf Downloads 72

References

1. Abraham A, Job AM, Roga G. Approach to Infantile Hemangiomas. Indian J Dermatol. 2016 Mar-Apr;61(2):181-6. doi: 10.4103/0019-5154.177755. PMID: 27057018; PMCID: PMC 4817443.
2. Qian Lin, Beichen Cai, Xiuying Shan, Xuejun Ni, Xuanfeng Chen, Ruonan Ke, Biao Wang, Global research trends of infantile hemangioma: A bibliometric and visualization analysis from 2000 to 2022, Heliyon, Volume 9, Issue 11, 2023, e21300.
3. Jung HL. Update on infantile hemangioma. Clin Exp Pediatr. 2021 Nov;64(11):559-572. doi: 10.3345/cep.2020.02061. Epub 2021 May 26. PMID: 34044479; PMCID: PMC8566803.
4. Krowchuk DP, Frieden IJ, Mancini AJ, Darrow DH, Blei F, Greene AK, et al. Clinical practice guideline for the management of infantile hemangiomas. Pediatrics. 2019;143:e20183475.
5. Chen ZY, Wang QN, Zhu YH, Zhou LY, Xu T, He ZY, et al. Progress in the treatment of infantile hemangioma. Ann Transl Med. 2019;7:692.
6. Aletaha M, Salour H, Bagheri A, Raffati N, Amouhashemi N. Oral propranolol for treatment of pediatric capillary hemangiomas. J Ophthalmic Vis Res. 2012 Apr;7(2):130-3. PMID: 23275821; PMCID: PMC3520472.
7. Kathleen F. O'Brien, Sonal D. Shah, Elena Pope, Roderic J. Phillips, Francine Blei, Eulalia Baselga, Maria C. Garzon, Catherine McCuaig, Anita N. Haggstrom, Peter H. Hoeger, James R. Treat, Marissa J. Perman, Jane S. Bellet, Xavier Cubiró, Jeffrey Poole, Ilona J. Frieden, Late growth of infantile hemangiomas in children >3 years of age: A retrospective study, Journal of the American Academy of Dermatology, Volume 80, Issue 2, 2019, Pages 493-499, //doi.org/10.1016/j.jaad.2018.07.061.
8. F.J. Melgosa Ramos, T. Díaz-Corpas, S. Santos-Alarcón, M. Galarreta Pascual, A. Aguado Vázquez, A. Mateu Puchades, Congenital and Infantile Hemangiomas: Epidemiological, Clinical, and Treatment Characteristics Based on 3 Years’ Experience at a Tertiary Care Hospital – A Retrospective Case Comparison and Review of the Literature, Actas Dermo-Sifiliográficas, Volume 114, Issue 7, 2023, Pages T631-T635, ISSN 0001-7310,
//doi.org/10.1016/j.ad.2023.01.017.
9. Sethuraman G, Yenamandra VK, Gupta V. Management of infantile hemangiomas: current trends. J Cutan Aesthet Surg. 2014 Apr;7(2):75-85. doi: 10.4103/0974-2077.138324. PMID: 25136206; PMCID: PMC4134656.
10. Tan X, Guo S, Wang C. Propranolol in the Treatment of Infantile Hemangiomas. Clin Cosmet Investig Dermatol. 2021;14:1155-1163 //doi.org/10.2147/CCID.S332625.
11. Prasad A, Sinha AK, Kumar B, Prasad A, Kumari M. Individualized dosing of oral propranolol for treatment of infantile hemangioma: a prospective study. Pan Afr Med J. 2019 Apr 8;32:155. doi: 10.11604/pamj.2019.32.155.16760. PMID: 31303926; PMCID: PMC6607273.