title: Initiation and use of propranolol for infantile hemangioma: report of a consensus conference.
abstract: Infantile hemangiomas (IHs) are common neoplasms composed of proliferating endothelial-like cells. Despite the relative frequency of IH and the potential severity of complications, there are currently no uniform guidelines for treatment. Although propranolol has rapidly been adopted, there is significant uncertainty and divergence of opinion regarding safety monitoring, dose escalation, and its use in PHACE syndrome (PHACE = posterior fossa, hemangioma, arterial lesions, cardiac abnormalities, eye abnormalities; a cutaneous neurovascular syndrome characterized by large, segmental hemangiomas of the head and neck along with congenital anomalies of the brain, heart, eyes and/or chest wall). A consensus conference was held on December 9, 2011. The multidisciplinary team reviewed existing data on the pharmacologic properties of propranolol and all published reports pertaining to the use of propranolol in pediatric patients. Workgroups were assigned specific topics to propose protocols on the following subjects: contraindications, special populations, pretreatment evaluation, dose escalation, and monitoring. Consensus protocols were recorded during the meeting and refined after the meeting. When appropriate, protocol clarifications and revision were made and agreed upon by the group via teleconference. Because of the absence of high-quality clinical research data, evidence-based recommendations are not possible at present. However, the team agreed on a number of recommendations that arose from a review of existing evidence, including when to treat complicated IH; contraindications and pretreatment evaluation protocols; propranolol use in PHACE syndrome; formulation, target dose, and frequency of propranolol; initiation of propranolol in infants; cardiovascular monitoring; ongoing monitoring; and prevention of hypoglycemia. Where there was considerable controversy, the more conservative approach was selected. We acknowledge that the recommendations are conservative in nature and anticipate that they will be revised as more data are made available.
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA. bdrolet@mcw.edu
authors.forename: Beth A
authors.initials: BA
authors.lastname: Drolet
authors.forename: Peter C
authors.initials: PC
authors.lastname: Frommelt
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Chamlin
authors.forename: Anita
authors.initials: A
authors.lastname: Haggstrom
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Bauman
authors.forename: Yvonne E
authors.initials: YE
authors.lastname: Chiu
authors.forename: Robert H
authors.initials: RH
authors.lastname: Chun
authors.forename: Maria C
authors.initials: MC
authors.lastname: Garzon
authors.forename: Kristen E
authors.initials: KE
authors.lastname: Holland
authors.forename: Leonardo
authors.initials: L
authors.lastname: Liberman
authors.forename: Susan
authors.initials: S
authors.lastname: MacLellan-Tobert
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Mancini
authors.forename: Denise
authors.initials: D
authors.lastname: Metry
authors.forename: Katherine B
authors.initials: KB
authors.lastname: Puttgen
authors.forename: Marcia
authors.initials: M
authors.lastname: Seefeldt
authors.forename: Robert
authors.initials: R
authors.lastname: Sidbury
authors.forename: Kendra M
authors.initials: KM
authors.lastname: Ward
authors.forename: Francine
authors.initials: F
authors.lastname: Blei
authors.forename: Eulalia
authors.initials: E
authors.lastname: Baselga
authors.forename: Laura
authors.initials: L
authors.lastname: Cassidy
authors.forename: David H
authors.initials: DH
authors.lastname: Darrow
authors.forename: Shawna
authors.initials: S
authors.lastname: Joachim
authors.forename: Eun-Kyung M
authors.initials: EK
authors.lastname: Kwon
authors.forename: Kari
authors.initials: K
authors.lastname: Martin
authors.forename: Jonathan
authors.initials: J
authors.lastname: Perkins
authors.forename: Dawn H
authors.initials: DH
authors.lastname: Siegel
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Boucek
authors.forename: Ilona J
authors.initials: IJ
authors.lastname: Frieden
mesh_terms: D003245:Consensus Statements as Topic; D006391:Hemangioma / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007223:Infant; D011433:Propranolol / Q000627:therapeutic use*; D058028:Research Report; D019043:Vascular Neoplasms / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology
chemical_list: D011433:Propranolol