Treatment of complicated infantile hemangiomas* with oral propranolol
Treatment of complicated infantile hemangiomas* with oral propranolol
ECG: electrocardiogram; MRI: magnetic resonance imaging; PHACE: posterior fossa brain malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities; bpm: beats per minute. * Complicated hemangiomas include:
Large hemangiomas at increased risk of scarring or disfigurement
Life-threatening hemangiomas
Hemangiomas carrying functional risks
Ulcerated hemangiomas
¶ Postnatal age in weeks minus number of weeks preterm. Δ Falsely low or high blood pressure measurements may occur if an inappropriate cuff size is used. In addition, the infant's behavioral state (crying/agitated versus calm/sleeping) can greatly impact blood pressure measurements. Refer to UpToDate topics on measurement of blood pressure in infants and children. ◊ Baseline head/neck MRI with angiography is also preferred in infants with large facial hemangiomas at risk for PHACE prior to initiating propranolol; however, in infants needing urgent treatment, propranolol may be given in the wait for neuroimaging results. Propranolol can be initiated at a lower dose and slowly titrated up to a maximum dose of 1 mg/kg/day. § This is a suggested initial dose; however, the initial dose and titration may vary according to local protocols. ¥ Serious adverse reactions:
Bradycardia (<90 bpm in newborns and infants ≤3 months)
Hypotension
Bronchospasm
Hypoglycemia
Refer to UpToDate topics on beta-blocker toxicity. ‡ Early signs of hypoglycemia:
Sweating (most important, not masked by beta blockers)
Jitteriness
Irritability
Cyanosis
Poor feeding
Hypothermia
Lethargy
Refer to UpToDate topics on hypoglycemia in infancy.