title: Initial experience with a multidisciplinary strategy for initiation of propranolol therapy for infantile hemangiomas.
abstract: OBJECTIVE
  To outline a safe, standardized protocol for outpatient initiation of propranolol therapy for infantile hemangiomas.
  
  
  METHODS
  Retrospective review.
  
  
  METHODS
  Academic tertiary care pediatric hospital.
  
  
  METHODS
  Forty-nine infantile hemangioma patients were offered propranolol therapy and included in the study. Any patients requiring hospital admission were excluded. Screening consisted of cardiology evaluation, including electrocardiography and, when indicated, echocardiography. Target initiation dose was 2 to 3 mg/kg/d divided into 3 doses. Blood pressure and heart rate were initially monitored at baseline and 1 and 2 hours in clinic following initial dosing. A 3-hour time point was later added. Families received standardized instructions regarding home heart rate monitoring, side effects, and fasting.
  
  
  RESULTS
  Outpatient propranolol therapy was safely initiated in 39 of 44 patients (89%). Five patients required brief admission: 1 with clinical signs/symptoms of heart failure, 3 having airway involvement, and 1 for social reasons. Propranolol administration transiently reduced blood pressure; the maximal decrease occurred at 2 hours, prompting addition of a 3-hour time point to ensure recovery. No patients exhibited symptomatic hypotension, bradycardia, or heart failure.
  
  
  CONCLUSIONS
  In most children with infantile hemangiomas, propranolol therapy can be safely initiated as an outpatient. Careful cardiovascular evaluation by an experienced clinician is essential for pretreatment evaluation, inpatient admission (when necessary), blood pressure and heart rate monitoring following initial dosing, and parent education. This standardized multidisciplinary outpatient initiation plan reduces the cost of initiating therapy compared with inpatient strategies while still providing appropriate monitoring for potential treatment complications. Further evaluation of propranolol therapy efficacy at the current dosing and duration of treatment continues.
authors.affiliation: Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington 98105-0371, USA.
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Cushing
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Boucek
authors.forename: Scott C
authors.initials: SC
authors.lastname: Manning
authors.forename: Robert
authors.initials: R
authors.lastname: Sidbury
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Perkins
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D001794:Blood Pressure / Q000187:drug effects; D002319:Cardiovascular System / Q000187:drug effects* / Q000503:physiopathology; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D006339:Heart Rate / Q000187:drug effects; D006391:Hemangioma / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D008297:Male; D010045:Outpatients; D011433:Propranolol / Q000008:administration & dosage*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol