title: Multicenter Evaluation of the Effectiveness of Systemic Propranolol in the Treatment of Airway Hemangiomas.
abstract: OBJECTIVE
  To evaluate the effectiveness of systemic propranolol in airway infantile hemangioma (AIH) treatment.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Patients with AIH treated with propranolol between 2009 and 2012 with at least a 1-year follow-up.
  
  
  RESULTS
  Presenting age, treating institution, syndrome presence, presenting AIH stage, endoscopy status, propranolol initiation location/dose/duration, time to stridor resolution, adjunctive medical and surgical therapy, and treatment-associated complications.
  
  
  RESULTS
  Twenty-seven patients met inclusion criteria. Average age of diagnosis was 2.3 months (range, 1-5 months). The AIHs were stage 1 in 7 of 27 (26%), stage 2 in 12 of 27 (44%), and stage 3 in 8 of 27 (30%). Propranolol initiation was inpatient in 25 of 27 (93%) and outpatient in 2 of 27 (7%). Propranolol dose was maintained at 2 mg/kg/d in all patients for a minimum of 7 months (range, 7-34 months; median, 15 months). Stridor was eliminated within 24 hours or less of propranolol initiation in 23 of 27 (85%). At diagnosis, staging and propranolol initiation in 11 of 27 (41%) were managed with propranolol alone; the remaining 16 of 27 (59%) also had a steroid injection. The use of adjuvant therapy at the time of propranolol initiation and the size of the AIH were not statistically correlated. Twelve patients had additional treatments after the initiation of propranolol due to recurrence of respiratory symptoms, 1 of 27 (4%) of whom was considered a nonresponder. No complications related to propranolol use were noted.
  
  
  CONCLUSIONS
  This multisite study of AIH treatment with propranolol demonstrates similar effectiveness to surgical treatment modalities. Propranolol therapy for AIH had no complications, had potentially lower resource utilization, and should be considered a first-line AIH treatment.
authors.affiliation: Divsion of Pediatric Otolaryngology, Dayton Children's Hospital, Dayton, Ohio, USA ellurur@childrensdayton.org.
authors.forename: Ravindhra G
authors.initials: RG
authors.lastname: Elluru
authors.affiliation: Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Melanie R
authors.initials: MR
authors.lastname: Friess
authors.affiliation: Divsion of Pediatric Otolaryngology, Arkansas Children's Hospital, Little Rock, Arkansas, USA.
authors.forename: Gresham T
authors.initials: GT
authors.lastname: Richter
authors.affiliation: Divison of Pediatric Otolaryngology, University of Utah Medical Center, Salt Lake City, Utah, USA.
authors.forename: J Fred
authors.initials: JF
authors.lastname: Grimmer
authors.affiliation: Divison of Pediatric Otolaryngology, Children's Hospital of The King's Daughter, Norfolk, Virginia, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Darrow
authors.affiliation: Divison of Pediatric Otolaryngology, Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Shin
authors.affiliation: Division of Pediatric Otolaryngology, Seattle Children's Hospital, Seattle, Washington, USA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Perkins
mesh_terms: D000402:Airway Obstruction / Q000188:drug therapy*; D004724:Endoscopy; D005260:Female; D006391:Hemangioma / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007822:Laryngeal Neoplasms / Q000188:drug therapy*; D008297:Male; D011433:Propranolol / Q000627:therapeutic use*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D014665:Vasodilator Agents; D011433:Propranolol
keywords: airway; breathing; infant; infantile hemangioma; larynx; pharynx; propranolol; stridor; subglottic hemangioma; subglottic stenosis; subglottis; surgery; trachea