title: A New Perspective for Infantile Hepatic Hemangioma in the Age of Propranolol: Experience at Baskent University.
abstract: Propranolol was first used in 2008 to treat hemangioma; its efficacy and safety have since changed the classical treatment indications. Infantile hepatic hemangioma presents as a spectrum of clinical conditions varying from simple asymptomatic lesions to lethal complications. Tufted hemangioma and Kaposiform hemangioendothelioma are congenital vascular tumors that lead to Kasabach-Merritt syndrome. Hemangiomas, like pure arteriovenous malformations, can cause hyperdynamic heart failure, and diffuse nodular-type hemangiomas can present with hypothyroidism. Respiratory problems and hepatic failure can be associated with diffuse nodular-type liver hemangiomas. There is a spectrum of approaches to management, varying from "watchful waiting" to liver transplant. In the age of propranolol, there has been a prominent change in the infantile hepatic hemangioma treatment algorithm. Our suggestion is early treatment with 3 mg/kg/day propranolol plus 1.0 to1.5 mg/kg/day prednisolone in all patients. This protocol is the most effective strategy for type 3 infantile hepatic hemangioma. Approximately one-third of patients with abdominal compartment syndrome in the era before propranolol treatment required liver transplant; this new treatment obviates transplant for many of these patients.
authors.affiliation: Department of Pediatric Oncology-Hematology, Baskent University Faculty of Medicine, Ankara, Turkey.
authors.forename: Faik
authors.initials: F
authors.lastname: Sarıalioğlu
authors.forename: Nalan
authors.initials: N
authors.lastname: Yazıcı
authors.forename: Ayşe
authors.initials: A
authors.lastname: Erbay
authors.forename: Fatih
authors.initials: F
authors.lastname: Boyvat
authors.forename: Şenay
authors.initials: Ş
authors.lastname: Demir
authors.forename: Figen
authors.initials: F
authors.lastname: Özçay
authors.forename: Nihal
authors.initials: N
authors.lastname: Uslu
mesh_terms: D017668:Age of Onset; D000465:Algorithms; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D019091:Critical Pathways; D005260:Female; D006391:Hemangioma / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000473:pathology; D016031:Liver Transplantation; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D011433:Propranolol / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014421:Turkey; D014495:Universities
chemical_list: D011239:Prednisolone; D011433:Propranolol