Propranolol in the management of airway infantile hemangiomas.
OBJECTIVE
To report our experience with propranolol in managing airway infantile hemangiomas.


METHODS
Case series of 3 consecutive patients who had extensive, symptomatic airway infantile hemangiomas treated with propranolol.


METHODS
Tertiary academic medical center.


METHODS
Three infants with facial cutaneous hemangiomas who developed stridor that progressed to respiratory distress, which according to laryngoscopic examination results was confirmed to be caused by extensive subglottic hemangiomas. These patients underwent follow-up during their course of therapy, ranging from 3 weeks to 15 months.


RESULTS
Patient 1 failed to respond to systemic corticosteroids, laser ablation, and intravenous vincristine for her airway hemangioma and had to undergo tracheotomy. She was given propranolol after her tracheotomy and had a significant reduction in her subglottic airway obstruction. Patient 2 developed progressive stridor secondary to airway hemangioma at age 6 1/2 months following tapering of systemic corticosteroids prescribed for her periorbital hemangioma. Systemic corticosteroids were restarted with the addition of propranolol. The stridor improved within 24 hours, and she was able to be weaned off corticosteroids. Patient 3 was also treated with initial combined therapy of systemic corticosteroids and propranolol. He had a significant reduction in stridor within 24 hours and was weaned off corticosteroids.


CONCLUSIONS
Our 3 patients had severe respiratory symptoms related to their airway infantile hemangiomas. In the first patient, propranolol was used when other treatments were ineffective or associated with intolerable adverse effects. In the second and third patients, propranolol was part of a dual regimen that resulted in rapid resolution of airway symptoms and allowed for quicker weaning of corticosteroids.
Rosbe
Kristina W
KW
Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, 2330 Post St, Ste 310, San Francisco, CA 94143-0342, USA. krosbe@ohns.ucsf.edu
Suh
Ki-Young
KY
Meyer
Anna K
AK
Maguiness
Sheilagh M
SM
Frieden
Ilona J
IJ
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000402:Airway Obstruction / Q000151:congenital / Q000628:therapy; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D005931:Glottis / Q000473:pathology*; D006391:Hemangioma / Q000151:congenital / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007822:Laryngeal Neoplasms / Q000151:congenital / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D007828:Laryngoscopy; D008297:Male; D011433:Propranolol / Q000627:therapeutic use*; D018570:Risk Assessment; D012494:Sampling Studies; D012878:Skin Neoplasms / Q000151:congenital / Q000175:diagnosis / Q000628:therapy; D014139:Tracheostomy / Q000379:methods; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D011433:Propranolol