gms | German Medical Science

Background: Oral propranolol therapy (OPT) has emerged as an effective first-line treatment for infantile hemangiomas (IH). The purpose of the study was to identify the sensible initial diagnostics prior to OPT, as well as the predictors of adverse events after treatment discontinuation in own cohort of children.

Materials and methods: Retrospective chart review of infants with IH ungergoing OPT under the age of 12 months. The initial diagnostics, clinical response, and outcome after OPT discontinuation were recorded.

Results: A total of 231 cases were evaluated. Prior to OPT an echocardiogram and electrocardiogram were performed in 228 cases (98.7%) and showed findings in respectively 111 (48.7%) and 19 cases (8.3%). However, none of these findings represented a contraindication for OPT. The mean age at OPT start was 3.7±0.2 months, the average duration of OPT was 6.1±0.1 months. After a mean follow-up period of 12.2±0.8 months following OPT discontinuation, 27 infants (11.7%) developed adverse events of the IH necessitating a restart of the OPT for a mean duration of 4.1±1.2 months. The solely adverse events predictor was the IH localisation in the head/neck region (OR 3.4, 95% CI 1.4-8.5, p=0.009).

Conclusion: These data suggest that echocardiogram and electrocardiogram are not resonable diagnostics to provide valuable information towards exclusion of contraindication to OPT. Further, we present a high adverse events rate after OPT discontinuation in our series. Infants with IH of the head/neck region have a threefold higher risk for adverse events. Our study reinforces the need for further examination of specific OPT modifications in this high risk-group.