title: Oral Nadolol for the Treatment of Infantile Hemangiomas: A Single-Institution Retrospective Cohort Study.
abstract: BACKGROUND
  Beta-blockers have become the treatment of choice for problematic infantile hemangiomas (IHs). Nadolol, a nonselective beta-blocker with potential dosing advantages and a better safety profile than that of other beta-blockers, has been studied as an alternative therapeutic option. Our objective was to characterize the efficacy and safety of oral nadolol in the treatment of proliferating IHs.
  
  
  METHODS
  A retrospective cohort study was conducted at the Hospital for Sick Children between February 2010 and April 2012 in patients treated with nadolol for proliferating IHs causing functional impairment or cosmetic disfigurement. The primary outcome was the percentage involution measured independently by two assessors who scored changes in the extent of IHs by comparing serial photographs using a 100-mm visual analogue scale (VAS), on which 5 mm represented 10% change.
  
  
  RESULTS
  Forty-four patients treated with nadolol for IHs with adequate photographic documentation were identified. The median age at presentation was 4.5 months (interquartile range 1.5-7.9 mos). There was a mean improvement of 91.8 ± 11.1%. At least 50% improvement was noted in 42 (95%) patients and 75% improvement in 39 (89%) patients. The mean time to 50% and 75% improvement was 2.9 and 3.7 months, respectively. Analysis of variance showed that younger age at the time of treatment start was associated with a higher mean VAS score (% involution) (p < 0.05). Treatment duration (mean 9.5 ± 5.6 months) had no significant effect on VAS score. Test of interobserver correlation showed good agreement (intraclass correlation coefficient = 0.86, p = 0.001).
  
  
  CONCLUSIONS
  Oral nadolol is efficacious in patients with problematic IHs. Further large-scale prospective comparative studies are warranted to compare nadolol with other beta-blockers.
authors.affiliation: Section of Dermatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Harkamal Kaur
authors.initials: HK
authors.lastname: Randhawa
authors.affiliation: Section of Dermatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Cathryn
authors.initials: C
authors.lastname: Sibbald
authors.affiliation: Section of Dermatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Garcia Romero
authors.affiliation: Section of Dermatology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Elena
authors.initials: E
authors.lastname: Pope
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002170:Canada; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006391:Hemangioma / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D008297:Male; D009248:Nadolol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D009248:Nadolol