Predicting complications with pretreatment testing in infantile haemangioma treated with oral propranolol.
Since 2008, orally administered propranolol has rapidly gained acceptance as the preferred therapy for haemangiomas, and is usually initiated by ophthalmologists, dermatologists or plastic surgeons who do not routinely use propranolol for any other indication. During the initial years when experience was limited, most healthcare professionals justifiably adopted a cautious approach when initiating and monitoring treatment. A consensus recommendation from the American Society of Dermatologists suggests routine observation, monitoring and cardiology assessments prior to propranolol initiation.



This study aims to analyse treatment initiation in a large tertiary children's hospital and investigate the value of pretreatment testing in predicting commonly seen adverse reactions of propranolol.



104 eligible patients treated between January 2009 and July 2012 were included. All patients underwent pretesting either with protocol A (administration of test dose with routine observations) or protocol B (cardiology clinic assessment, including two-dimensional echocardiography without test dose).



38.5% (40/104) of patients developed adverse reactions during treatment; however, there were no severe or life-threatening reactions. Protocol A has a sensitivity of 0 (95% CI 0 to 0.17) and specificity of 0.95 (95% CI 0.83 to 0.99). Protocol B has a sensitivity of 0.07 (95% CI 0 to 0.34) and specificity of 0.86 (95% CI 0.63 to 0.96).



The predictive values of both protocols for the commonly observed adverse reactions are low. In this series, there is no evidence to suggest that routine pretreatment testing before propranolol initiation is of any value in otherwise healthy children.
Birmingham Children's Hospital, Birmingham, UK.
Lilian Yh
LY
Tang
Birmingham Children's Hospital, Birmingham, UK.
Jeremy Wg
JW
Hing
Birmingham Children's Hospital, Birmingham, UK.
Jasmine Ym
JY
Tang
Birmingham Children's Hospital, Birmingham, UK.
Hiroshi
H
Nishikawa
Birmingham Children's Hospital, Birmingham, UK.
Hossain
H
Shahidullah
Birmingham Children's Hospital, Birmingham, UK.
Fiona
F
Browne
Birmingham Children's Hospital, Birmingham, UK.
Ashish
A
Chikermane
Birmingham Children's Hospital, Birmingham, UK.
Manoj
M
Parulekar
D000284:Administration, Oral; D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D018324:Hemangioma, Capillary / Q000175:diagnosis / Q000188:drug therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011433:Propranolol / Q000008:administration & dosage*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D013997:Time Factors; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D011433:Propranolol
Child health (paediatrics); Drugs; Pharmacology; Treatment Medical