title: Oral Nadolol for Children with Infantile Hemangiomas and Sleep Disturbances with Oral Propranolol.
abstract: OBJECTIVE
  Oral propranolol has been shown to be safe and effective in infants with infantile hemangioma (IH). Side effects such as sleep disturbances have been associated with propranolol. The aim of this study was to evaluate the efficacy and safety of oral nadolol in a small series of patients whose propranolol therapy was discontinued due to sleep disturbances.
  
  
  METHODS
  A retrospective study of patients with IHs who were treated with oral nadolol due to propranolol-related sleep disturbances at a pediatric tertiary care center between July 2008 and March 2013. Clinical response to oral nadolol and disappearance of propranolol-related side effects were analyzed.
  
  
  RESULTS
  A total of 97 patients presenting IH received oral propranolol. Nine patients (9.3%) developed sleep disturbances. Oral propranolol was discontinued in seven patients and switched to oral nadolol, with resolution of these side effects in 5 (71%) of the cases. One patient developed sleep disturbances again after four months of oral nadolol.
  
  
  CONCLUSIONS
  The sample size was too small to draw generalizable conclusions and to draw any statistical inference as to the incidence of sleep disturbances with nadolol therapy.
  
  
  CONCLUSIONS
  The use of oral nadolol in the treatment of IH in our series of 7 patients, resolved the propranolol-related sleep disturbances in 5 (71%), while in one patient the symptoms recurred after 4 months of oral nadolol at a dose of 2 mg/kg/day. In most cases, switching beta-blockers did not compromise efficacy, and is recommended when sleep disturbance necessitates discontinuation of beta-blocker therapy of IH.
authors.affiliation: Department of Dermatology, Virgen del Rocio University Hospital, Seville, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Bernabeu-Wittel
authors.affiliation: Department of Dermatology, Virgen del Rocio University Hospital, Seville, Spain.
authors.forename: Basilio
authors.initials: B
authors.lastname: Narváez-Moreno
authors.affiliation: Department of Dermatology, Virgen del Rocio University Hospital, Seville, Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: de la Torre-García
authors.affiliation: Department of Pediatric Surgery, Virgen del Rocio University Hospital, Seville, Spain.
authors.forename: Israel
authors.initials: I
authors.lastname: Fernández-Pineda
authors.affiliation: Department of Dermatology, Virgen del Rocio University Hospital, Seville, Spain.
authors.forename: Javier Jesús
authors.initials: JJ
authors.lastname: Domínguez-Cruz
authors.affiliation: Department of Pediatric Cardiology, Virgen del Rocio University Hospital, Seville, Spain.
authors.forename: Félix
authors.initials: F
authors.lastname: Coserría-Sánchez
authors.affiliation: Department of Pharmacy, Virgen del Rocio University Hospital, Seville, Spain.
authors.forename: Concha
authors.initials: C
authors.lastname: Álvarez-del-Vayo
authors.affiliation: Department of Dermatology, Virgen del Rocio University Hospital, Seville, Spain.
authors.forename: Julián
authors.initials: J
authors.lastname: Conejo-Mir
mesh_terms: D000284:Administration, Oral; D016009:Chi-Square Distribution; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D018324:Hemangioma, Capillary / Q000151:congenital / Q000188:drug therapy* / Q000503:physiopathology; D006801:Humans; D007223:Infant; D008297:Male; D009248:Nadolol / Q000008:administration & dosage*; D061214:Patient Safety; D011379:Prognosis; D011433:Propranolol / Q000009:adverse effects / Q000627:therapeutic use; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000151:congenital / Q000188:drug therapy* / Q000503:physiopathology; D012893:Sleep Wake Disorders / Q000139:chemically induced* / Q000503:physiopathology; D016896:Treatment Outcome; D028761:Withholding Treatment
chemical_list: D009248:Nadolol; D011433:Propranolol