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Propranolol Therapy for Problematic Hemangioma
Ng M, MD; Candace Knuth, PA-C; Chris Weisbrod, MBA; Ananth S. Murthy, MD, FACS
Hospital
2014-02-26
Presenter: Marilyn Ng, MD
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting.
The above work represents 75% of the original work of the resident.
Director Name: Douglas Wagner, MD
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background
Infantile hemangioma (IH) is a common, benign tumor occurring in up to 10% of Caucasian infants. Propranolol has emerged as a front-line therapy for infantile hemangioma. The present study examined the response of propranolol therapy on hemangioma size.
Methods
Twenty-seven children (4 to 20 weeks old) with IH were enrolled into the study of oral propranolol solution 2 mg/kg/day divided 3 times daily for 10 months. Response was assessed by size measurements at pre- and post-treatment. Scoring was stratified into no response, plateau, and regression groups. Secondary outcomes measured were drug compliance and complications.
Results
Twenty-seven consecutive patients with IH were treated with propranolol, of whom 40% completed six-month therapy. No correlation was demonstrated between lesion size and age at therapy initiation or patient (p=0.7 and p=0.7, respectively). A large number of infants responded to therapy (85.2%). Response was first observed sooner in the regression group compared to plateau responders (15.15¡À8.06 and 20.5¡À18.42 days, respectively). A significant difference in median pre- and post-treatment lesion size was noted (4.50 vs 1.55 cm2, p=0.02). Lesion regression was observed if pre-treatment lesion size was ¡Ü6.7 cm2 and no response if the size was >7.7 cm2. Attrition was secondary to drug-induced side effects, no response, and dosing non-compliance.
Conclusions
Propranolol is a safe and effective first-line therapy for problematic infantile hemangiomas. Therapy should show significant response by 2 weeks. If no response is observed by 3 weeks, then other treatment should be sought.
Clinical Question/Level of Evidence: Therapeutic, II
