Role of Propranolol in Management of Infantile Haemangioma: Our Experience

Abstract

Background: Infantile hemangiomas are the most common vascular tumors in infants and the most common benign soft-tissue
tumors in infants and children with a prevalence of 4-10%. Most of the haemangiomas are self-resolving by the age of 7 years but
few present as a challenge for management. Up to 30% require treatment like systemic corticosteroids, laser therapy, interferon-á,
cryotherapy, embolization, radiotherapy, and intralesional sclerotherapy, all showing variable results. Since 2008 propranolol is
effective in the management of challenging cases. At present, although many international and national studies have been done to
evaluate different treatment modalities of infantile hemangioma, none is done in our local setups. Moreover, there is no specific
agreed dose or guidelines. for the use of propranolol in the management of infantile hemangioma for which our results can help.
Objectives: This study aimed to evaluate the therapeutic effect of propranolol in the management of infantile hemangioma in our
population to help in developing a proper dose regime with minimum adverse effects.
Materials And Methods: This prospective interventional study was conducted in the department of Pediatric surgery Bacha Khan
Medical Complex, Swabi, Pakistan. The duration of the study was 26 months. After detailed history and investigation, the patients
were started on a lower dose (1mg/kg/day in three divided doses) of propranolol and observed for six hours in the ward. After one
week the dose was increased (2 mg/kg/day in three divided doses). The outcome was presented in terms of the percentage of
regression of the mass as effective or non-effective.
Results: A total of 18 patients were treated with propranolol with a male to female ratio of 1:4. All patients tolerated the dose and had
minimal side effects. All patients responded to the treatment with some early responders (n=16, 88.8%) while others responding
late.
Conclusion: Our study showed that propranolol starting at a low dose after six months of age with gradually increasing it can have
a good outcome with minimal side effects. Hence looking at its safety, we can say that propranolol can be given for small and nonproblematic hemangiomas as well.
Keywords: Infantile Hemangioma, therapeutic effect, propranolol