Published in Dermatology Journal Scan / Research · March 19, 2022 Safety of Propranolol for Infantile Hemangioma in Infants <5 Weeks Corrected Age Pediatric Dermatology

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• This single institution, retrospective study identified 24 infants <5 weeks corrected age (<45 weeks corrected gestational age) with infantile hemangiomas (IH) treated with propranolol. Overall, 22 patients showed improvement of their IH and 3 patients stopped propranolol between 3 days and 4 weeks after initiation due to side effects including fussiness, feeding difficulties, and sleep disturbances. No serious adverse events were reported.

• Propranolol appears to be an effective and safe treatment option for IH in infants <5 weeks corrected age; however, evidence-based guidelines are required for appropriate monitoring.

–  Kelly B. Scarberry, MD

Written by

 

 

Sarah L. Chamlin MD

These authors examine the safety and efficacy of propranolol use in very young infants, <45 weeks corrected gestation age, with hemangiomas. In this cohort of 24 infants, there were no serious adverse events. The most common side effects included sleep disturbance, irritability and cool hands and feet. 

Very young infants often need oral propranolol to stop the growth of function or appearance threatening hemangiomas before peak proliferation occurs, sometimes between 5-7 weeks of life. Unfortunately, this propranolol is administered with worry and hesitation under 6 weeks of life. This and other reports provide reassuring evidence of the safety in this group. Notably, past initiation protocols suggested hospital admission and monitoring for this young group, and 21 of these infants had propranolol initiated in an outpatient setting with most starting at 1mg/kg/day. As evidence like this grows, outpatient propranolol initiation in select young infants may become more commonplace. 

Abstract 

BACKGROUND/OBJECTIVES

Propranolol is used to treat problematic infantile hemangiomas (IHs), but its safety in infants <5 weeks corrected age has not been established. The objective of this study was to assess the safety and efficacy of propranolol for treatment of IH in infants <5 weeks corrected age, or 45 weeks corrected gestational age (CGA).

METHODS

We performed a single institution, retrospective review of patients treated with propranolol prior to the age of 6 months between 2017 and 2021. Patient characteristics, location of hemangioma(s), weight at initiation of treatment, dosing information, side effects, response, and duration of treatment were documented.

RESULTS

Of 200 patients with IH treated with propranolol, 24 started treatment prior to 45 weeks CGA. Mean CGA at initiation of treatment was 42 weeks. Sixty-seven percent were female and 75% were white, non-Hispanic. Mean duration of treatment was 255 days. Twenty-two patients (92%) had clear benefit from treatment at a dose of 1-3 mg/kg/day. The most common side effects were sleep disturbance (21%), irritability (17%), and cool hands/feet (13%). There were no serious adverse events.

CONCLUSIONS

In this cohort of 24 patients with corrected age <5 weeks (CGA <45 weeks), propranolol was safe and effective for the treatment of infantile hemangiomas. Larger, prospective studies are indicated to investigate propranolol in this age group.

Pediatric Dermatology

Safety of propranolol for infantile hemangioma in infants less than five weeks corrected age

Pediatr Dermatol 2022 Mar 03;[EPub Ahead of Print], JE Gatts, MC Rush, JF Check, DM Samelak, TW McLean

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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