title: Propranolol in infantile haemangioma: simplifying pretreatment monitoring.
abstract: BACKGROUND
  Infantile haemangiomas (IHs) are very common vascular tumours. Propranolol is at present the first-line treatment for problematic and complicated haemangioma. In accordance with a Swiss protocol, children are monitored for 2 days at the start of the treatment to detect possible side effects of this drug. Our study advocates a simplification of the pretreatment monitoring process.
  
  
  METHODS
  All children with a problematic and complicated haemangioma treated with propranolol between September 2009 and September 2012 were included in the study. All patients were hospitalised under constant nurse supervision for 48 hours at the start of the treatment and subjected to cardiac and blood measurements. The dosage of propranolol was 1 mg/kg/day on the first day and 2 mg/kg/day from the second day. Demographic data, clinical features, treatment outcome and complications were analysed.
  
  
  RESULTS
  Twenty-nine infants were included in our study. Of these, 86.2% responded immediately to the treatment. There were no severe adverse reactions. Six patients presented transient side effects such as bradycardia, hypotension after the first dose and hypoglycaemia later. No side effects occurred after the second dose. Treatment was never interrupted.
  
  
  CONCLUSIONS
  Propranolol (a β-blocker) is a safe treatment for problematic IH. Side effects may occur after the first dose. A strict 48 hour monitoring in hospital is expensive and may be unnecessary as long as the contraindications for the drug are respected.
authors.affiliation: Department of Pediatric Surgery, University Hospital Center of the Canton of Vaud (CHUV), Lausanne, Switzerland.
authors.forename: Oumama
authors.initials: O
authors.lastname: El Ezzi
authors.forename: Judith
authors.initials: J
authors.lastname: Hohlfeld
authors.forename: Anthony
authors.initials: A
authors.lastname: de Buys Roessingh
mesh_terms: D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D016903:Drug Monitoring / Q000379:methods*; D004452:Echocardiography; D004562:Electrocardiography; D005153:Facial Neoplasms / Q000188:drug therapy*; D005260:Female; D005833:Genital Neoplasms, Female / Q000188:drug therapy*; D018324:Hemangioma, Capillary / Q000188:drug therapy*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007677:Kidney Function Tests; D008297:Male; D009386:Neoplastic Syndromes, Hereditary / Q000188:drug therapy*; D011433:Propranolol / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy*; D014665:Vasodilator Agents / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D014665:Vasodilator Agents; D011433:Propranolol