title: Propranolol therapy for infantile hemangioma is less toxic but longer in duration than corticosteroid therapy.
abstract: BACKGROUND
  Infantile hemangioma is the most common benign, self-limiting tumour of childhood. Treatment is reserved for hemangiomas that obstruct vital structures or cause significant disfigurement. Traditionally, corticosteroids have been the medical treatment of choice. Since 2008, however, propranolol has been rapidly adopted as an effective pharmacological treatment for infantile hemangioma. Published data regarding the long-term side effects of propranolol are currently lacking.
  
  
  OBJECTIVE
  To describe the long-term effects of propranolol and corticosteroids on anthropometric measurements (height, body mass index [BMI]) and blood pressure in children.
  
  
  METHODS
  A prospective database analysis of all infantile hemangioma patient visits to the pediatric vascular abnormality clinic at the authors' institution between October 2007 and February 2012 was performed. Anthropometric measures (height and BMI) and blood pressure were analyzed.
  
  
  RESULTS
  A total of 290 visits (119 patients) to the pediatric vascular abnormality clinic were reviewed. Of these, 18 patients received medical treatment and their anthropometry was analyzed. BMI percentile increased significantly in patients treated with corticosteroids (P=0.0039). Corticosteroid treatment also resulted in a significant decrease in height percentile (P=0.0078). Anthropometric measures did not cross percentiles in children treated with propranolol. A significant decrease in systolic blood pressure was noted in the propranolol group (P=0.03), but no hypotensive values were recorded. Median treatment duration was significantly longer when patients received propranolol (372 versus 133 days; P=0.0033).
  
  
  CONCLUSIONS
  Propranolol for the treatment of infantile vascular abnormalities does not share the unfavourable effects on patient anthropometry that corticosteroids exhibit; however, a longer duration of therapy is required.
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Western University;
authors.forename: Kathryn
authors.initials: K
authors.lastname: Sawa
authors.affiliation: Department of Surgery, Division of Plastic Surgery, Western University;
authors.forename: Arjang
authors.initials: A
authors.lastname: Yazdani
authors.affiliation: Department of Paediatrics, Children's Hospital at London Health Science Centre, Western University; ; Department of Medicine;
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Rieder
authors.affiliation: Department of Paediatrics, Children's Hospital at London Health Science Centre, Western University; ; Department of Medicine; ; Department of Pathology and Laboratory Medicine, Western University, London, Ontario.
authors.forename: Guido
authors.initials: G
authors.lastname: Filler
keywords: Hemangioma; Multidisciplinary clinic, Prednisolone; Prednisone; Propranolol; Surgical treatment