title: Propranolol therapy for reducing the number of nasal infantile hemangioma invasive procedures.
abstract: OBJECTIVE
  Propranolol therapy is changing the treatment paradigm for infantile hemangioma. This study addresses the effect of propranolol therapy on the treatment of nasal infantile hemangioma (NIH), an area that often does not respond to medical therapy.
  
  
  OBJECTIVE
  To determine if propranolol treatment is associated with fewer invasive treatments for NIH.
  
  
  METHODS
  Retrospective cohort study conducted within a single pediatric institution's multidisciplinary vascular anomaly program for patients with NIH treated between January 1, 2003, and December 31, 2011. Three NIH cohorts were compared: prepropranolol (20 in group 1; 2003-2009), propranolol (25 in group 2; 2009-2011), and nonpropranolol (13 in group 3; 2009-2011) treatment.
  
  
  METHODS
  Analysis of systemic medical, laser, or surgical therapies for NIH.
  
  
  METHODS
  The study plan was created to detect a change in invasive therapy for NIH. Data collected included presenting age, sex, affected nasal subunits, infantile hemangioma morphologic characteristics, treatment type and number, and primary treating service. An NIH grading system, based on nasal subunit involvement, helped quantify treatment change. Descriptive statistics summarized data, and a Cox proportional hazards regression model evaluated propranolol use and the likelihood of invasive treatments (surgical excision or laser).
  
  
  RESULTS
  Of the 95 patients identified, 58 met inclusion criteria: 20 in group 1 (mean age, 4.8 months), 25 in group 2 (mean age, 4.9 months), and 13 in group 3 (mean age, 4.9 months). Nasal infantile hemangiomas involved the nasal tip subunit in 33 of 58 patients (56.9%). Eight of 13 patients (61.5%) in group 3 frequently had small NIH (grade 1). Patients in group 2 were less likely to undergo any invasive treatments (relative risk, 0.44; 95% CI, 0.27-0.73), have surgical excision only (0.45; 0.15-1.38), or undergo laser treatment only (0.44; 0.27-0.78) compared with those in group 1. Patients with higher-grade NIH had more medical or invasive therapy, but invasive procedures were carried out in each subgroup defined by grade.
  
  
  CONCLUSIONS
  Patients with isolated propranolol-treated NIH were less likely to undergo invasive treatment, but despite its implementation, the need for invasive treatment was not totally supplanted by its use.
authors.affiliation: Seattle Children's Hospital Research Institute, Seattle, Washington2Division of Pediatric Otolaryngology-Head and Neck Surgery, Department of Surgery, Seattle Children's Hospital, Seattle, Washington3Department of Otolaryngology-Head and Neck Surgery, Uni.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Perkins
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Madigan Healthcare System, Tacoma, Washington.
authors.forename: Brian S
authors.initials: BS
authors.lastname: Chen
authors.affiliation: Seattle Children's Hospital Research Institute, Seattle, Washington.
authors.forename: Babette
authors.initials: B
authors.lastname: Saltzman
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, Department of Surgery, Seattle Children's Hospital, Seattle, Washington3Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Manning
authors.affiliation: Division of Pediatric Otolaryngology-Head and Neck Surgery, Department of Surgery, Seattle Children's Hospital, Seattle, Washington3Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle.
authors.forename: Sanjay R
authors.initials: SR
authors.lastname: Parikh
mesh_terms: D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006391:Hemangioma / Q000188:drug therapy* / Q000601:surgery; D006801:Humans; D053685:Laser Therapy / Q000706:statistics & numerical data; D008297:Male; D009669:Nose Neoplasms / Q000188:drug therapy* / Q000601:surgery; D013517:Otorhinolaryngologic Surgical Procedures / Q000706:statistics & numerical data*; D011433:Propranolol / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol