title: Is cardiovascular evaluation necessary prior to and during beta-blocker therapy for infantile hemangiomas?: A cohort study.
abstract: BACKGROUND
  Although consensus guidelines for pretreatment evaluation and monitoring of propranolol therapy in patients with infantile hemangiomas (IH) have been formulated, little is known about the cardiovascular side effects.
  
  
  OBJECTIVE
  We sought to analyze cardiovascular evaluations in patients with IH at baseline and during treatment with an oral beta-blocker.
  
  
  METHODS
  Data from 109 patients with IH were retrospectively analyzed. Patient and family history, pretreatment electrocardiogram (ECG), heart rate, and blood pressure were evaluated before initiation of beta-blocker therapy. Blood pressure and standardized questionnaires addressing side effects were evaluated during treatment.
  
  
  RESULTS
  Questionnaire analyses (n = 83) identified 3 cases with a family history of cardiovascular disease in first-degree relatives. ECG findings were normal in each case and no serious complication of therapy occurred. ECG abnormalities were found in 6.5% of patients but there were no contraindications to beta-blocker therapy and no major complications. Hypotension in 9 patients did not require therapy adjustment. In all, 88 parents (81%) reported side effects during beta-blocker treatment.
  
  
  CONCLUSIONS
  The relatively small patient cohort is a limitation.
  
  
  CONCLUSIONS
  Pretreatment ECG is of limited value for patients with an unremarkable cardiovascular history and a normal heart rate and blood pressure. Hypotension may occur during treatment.
authors.affiliation: Department of Pediatric Dermatology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Center for Congenital Vascular Anomalies Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: m.f.raphael-2@umcutrecht.nl.
authors.forename: Martine F
authors.initials: MF
authors.lastname: Raphael
authors.affiliation: Department of Pediatric Plastic Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Center for Congenital Vascular Anomalies Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Corstiaan C
authors.initials: CC
authors.lastname: Breugem
authors.affiliation: Department of Pediatric Dermatology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Florine A E
authors.initials: FA
authors.lastname: Vlasveld
authors.affiliation: Department of Pediatric Dermatology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Center for Congenital Vascular Anomalies Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Marlies
authors.initials: M
authors.lastname: de Graaf
authors.affiliation: Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Martijn G
authors.initials: MG
authors.lastname: Slieker
authors.affiliation: Department of Pediatric Dermatology and Allergology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Center for Congenital Vascular Anomalies Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Pediatric Dermatology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
authors.forename: Suzanne G M A
authors.initials: SG
authors.lastname: Pasmans
authors.affiliation: Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands; Center for Congenital Vascular Anomalies Utrecht, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Johannes M P J
authors.initials: JM
authors.lastname: Breur
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000139:chemically induced* / Q000175:diagnosis; D002675:Child, Preschool; D015331:Cohort Studies; D016903:Drug Monitoring; D004562:Electrocardiography; D005260:Female; D006391:Hemangioma / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011433:Propranolol / Q000627:therapeutic use*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy*
chemical_list: D000319:Adrenergic beta-Antagonists; D011433:Propranolol
keywords: beta-blocker therapy; cardiovascular side effects; infantile hemangioma; treatment evaluation