title: Propranolol for infantile hemangiomas: early experience at a tertiary vascular anomalies center.
abstract: OBJECTIVE
  Propranolol has recently been introduced as a novel pharmacologic treatment for infantile hemangiomas. Systematic examination of this treatment in a tertiary care setting has not been described. This study explores the impact of propranolol on both proliferative and involuting hemangiomas at a tertiary vascular anomalies center.
  
  
  METHODS
  Retrospective single institution review.
  
  
  METHODS
  We reviewed children treated with propranolol for problematic hemangiomas followed by a blinded prospective analysis of serial photographs taken during the course of their therapy. Parental questionnaires were obtained to evaluate perceived therapeutic response and complications to oral propranolol.
  
  
  RESULTS
  Thirty-two children with complete photo documentation were treated with oral propranolol for infantile hemangiomas between September 2008 and June 2009. Twenty-seven patients began therapy during the proliferative phase of their lesions (mean age, 4.9 months), whereas five patients began during the involutional phase (mean age, 19.4 months). Ninety-seven percent of patients displayed improvement in the quality of their hemangiomas during propranolol therapy. Patients were determined to be excellent responders (n = 16, 50%), partial responders (n = 15, 47%), or nonresponders (n = 1, 3%). Partial and nonresponders received adjuvant therapy (75%, laser therapy; 31%, steroid injections). Ten patients experienced minor but reportable side effects to propranolol, including somnolence (27.2%), gastroesophageal reflux (9.1%), respiratory syncytial virus exacerbation (4.5%), and rash (4.5%).
  
  
  CONCLUSIONS
  Propranolol may revolutionize the treatment of problematic hemangiomas that cause imminent functional or cosmetic sequelae. At therapeutic doses, propranolol is safe and effective in the majority of patients. Adjunctive therapies may still be required. Minor side effects, expected from beta-blocker therapy, are common but easily managed.
authors.affiliation: Department of Otolaryngology, Division of Pediatric Otolaryngology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas 72202, USA. buckmillerlisam@uams.edu
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Buckmiller
authors.forename: Patrick D
authors.initials: PD
authors.lastname: Munson
authors.forename: Umesh
authors.initials: U
authors.lastname: Dyamenahalli
authors.forename: Yuemeng
authors.initials: Y
authors.lastname: Dai
authors.forename: Gresham T
authors.initials: GT
authors.lastname: Richter
mesh_terms: D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D001131:Arkansas; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D006391:Hemangioma / Q000175:diagnosis / Q000188:drug therapy*; D006782:Hospitals, Special; D006801:Humans; D007223:Infant; D008297:Male; D010781:Photography; D011433:Propranolol / Q000008:administration & dosage / Q000627:therapeutic use*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol