Propranolol for the treatment of infantile hemangioma: Our experience at The Children’s Hospital, Lahore

Abstract

Objective To assess the effect of propranolol in growing infantile hemangioma (IH). Methods 122 children 68 girls and 54 boys, mean age 4.5 months, having IH were treated with oral propranolol. After taking baseline pulse, blood pressure, blood glucose level and echocardiography, propranolol was started at 0.5mg/kg body weight. Patients were monitored hourly for pulse, blood pressure and blood glucose level were noted and if no side effects noted for four hours, treatment was continued at home. Patients were reevaluated on day 10 and the dose was increased to 1.5-2 mg/kg daily in divided doses. Patients were followed up monthly for response and side effects. To avoid hypoglycemia in infants under the age of 3 months, mothers were advised to feed them every 2 hours. Results The earliest effect was change in color seen in all cases. Objective clinical evidence of softening and regression were seen after 2-3 weeks. Drug was given for mean period of 6.5 months. Overall clinical response was seen in 115 (94.3%) patients. It was graded as excellent (>75% improvement) in 92 (75.4%) and good (50-75% improvement) in 23 (18.9%) patients. Adverse effects during treatment were hypoglycemia 4 (3.3%), hypotension 3 (2.5%), cold extremities 2 (1.6%) and constipation 1 (0.8%). Relapse rate was none. Conclusion Propranolol given orally at 1.5-2.0 mg/kg/day has consistent, rapid therapeutic effect in shortening of natural course of IHs with good clinical safety.