title: Failure of propranolol in the treatment of childhood haemangiomas of the head and neck.
abstract: BACKGROUND
  Infantile haemangiomas enter a rapid proliferative phase within months of birth, before slowly involuting. Those with the potential for disfigurement or morbidity require intervention. Propranolol has emerged as an effective new treatment modality, with the potential to become the first-line treatment of choice.
  
  
  METHODS
  Four children with haemangiomas of the head and neck were treated with propranolol at a tertiary referral centre. The size of the haemangioma and the symptoms resulting from airway compromise were monitored.
  
  
  RESULTS
  Three of the four children showed a dramatic response to treatment with propranolol. However, one child responded initially but was readmitted with stridor secondary to new haemangioma proliferation.
  
  
  CONCLUSIONS
  We report a cautionary case in which a subglottic haemangioma developed contemporaneously with propranolol treatment, requiring surgical intervention. This finding highlights the need for regular follow up of treatment response, and the need for monitoring for treatment side effects.
authors.affiliation: Department of Paediatric Otorhinolaryngology, Royal Manchester Children's Hospital, UK. jaygoswamy@doctors.org.uk
authors.forename: J
authors.initials: J
authors.lastname: Goswamy
authors.forename: M P
authors.initials: MP
authors.lastname: Rothera
authors.forename: I A
authors.initials: IA
authors.lastname: Bruce
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000402:Airway Obstruction / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003371:Cough / Q000209:etiology; D003480:Cushing Syndrome / Q000139:chemically induced; D003937:Diagnosis, Differential; D004334:Drug Administration Schedule; D005260:Female; D005528:Foot; D005931:Glottis / Q000473:pathology*; D006258:Head and Neck Neoplasms / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D006391:Hemangioma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007223:Infant; D007828:Laryngoscopy; D008297:Male; D011433:Propranolol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012135:Respiratory Sounds / Q000209:etiology; D012878:Skin Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D014139:Tracheostomy; D017211:Treatment Failure
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D011433:Propranolol