title: Adverse effects of propranolol when used in the treatment of hemangiomas: a case series of 28 infants.
abstract: BACKGROUND
  Infantile hemangioma (IH) is a frequently encountered tumor with a potentially complicated course. Recently, propranolol was discovered to be an effective treatment option.
  
  
  OBJECTIVE
  To describe the effects and side effects of propranolol treatment in 28 children with (complicated) IH.
  
  
  METHODS
  A protocol for treatment of IH with propranolol was designed and implemented. Propranolol was administered to 28 children (21 girls and 7 boys, mean age at onset of treatment: 8.8 months).
  
  
  RESULTS
  All 28 patients had a good response. In two patients, systemic corticosteroid therapy was tapered successfully after propranolol was initiated. Propranolol was also an effective treatment for hemangiomas in 4 patients older than 1 year of age. Side effects that needed intervention and/or close monitoring were not dose dependent and included symptomatic hypoglycemia (n = 2; 1 patient also taking prednisone), hypotension (n = 16, of which 1 is symptomatic), and bronchial hyperreactivity (n = 3). Restless sleep (n = 8), constipation (n = 3) and cold extremities (n = 3) were observed.
  
  
  CONCLUSIONS
  Clinical studies are necessary to evaluate the incidence of side effects of propranolol treatment of IH.
  
  
  CONCLUSIONS
  Propranolol appears to be an effective treatment option for IH even in the nonproliferative phase and after the first year of life. Potentially harmful adverse effects include hypoglycemia, bronchospasm, and hypotension.
authors: Department of Pediatric Dermatology & Allergology, Center for Congenital Vascular Anomalies Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands. Electronic address: m.degraaf-10@umcutrecht.nl.
authors: Marlies
authors: M
authors: de Graaf
authors: Department of Pediatric Cardiology, Center for Congenital Vascular Anomalies Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Johannes M P J
authors: JMPJ
authors: Breur
authors: Department of Pediatric Hematology, Center for Congenital Vascular Anomalies Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Martine F
authors: MF
authors: Raphaël
authors: Department of Pediatric Dermatology & Allergology, Center for Congenital Vascular Anomalies Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Marike
authors: M
authors: Vos
authors: Department of Pediatric Plastic Surgery, Center for Congenital Vascular Anomalies Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Corstiaan C
authors: CC
authors: Breugem
authors: Department of Pediatric Dermatology & Allergology, Center for Congenital Vascular Anomalies Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands.
authors: Suzanne G M A
authors: SGMA
authors: Pasmans