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| hemangioma_treatment [2018/07/30 02:54] – Scott Larson | hemangioma_treatment [2025/04/18 20:40] (current) – external edit 127.0.0.1 | ||
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| ===== Propranolol ===== | ===== Propranolol ===== | ||
| ==== Dosing ==== | ==== Dosing ==== | ||
| - | + | === Preferred Dosing === | |
| - | * 1 mg/kg/d divided | + | * 1 mg/kg/d divided |
| - | * 2 mg/kg/d divided | + | * 1.5 mg/kg/d divided |
| - | * 3 mg/kg/d divided TID or BID- keep at this dose (can increase with change in weight) | + | * 2 mg/kg/d divided BID keep at this dose |
| - | * Minimum | + | == Common Alternate dosing == |
| + | * 1 mg/kg/d divided TID for 1 week | ||
| + | * 1.5 mg/kg/d divided TID for 1 week | ||
| + | * 2 mg/kg/d divided TID keep at this dose | ||
| + | == French RCT Dosing == | ||
| + | * 1 mg/kg/d divided BID for 1 week | ||
| + | * 2 mg/kg/d divided BID for 1 week | ||
| + | * 3 mg/kg/d divided BID | ||
| + | === Other Considerations === | ||
| + | * Try for 6 hours between doses | ||
| * Hold if child can't take PO | * Hold if child can't take PO | ||
| * Child should not skip meals | * Child should not skip meals | ||
| - | * Typically use for minimum 6 months | + | * Typically use for minimum 6 months, 12 months have less recurrences |
| * When lesion treated, tapering is common to ensure no recurrence of the lesion | * When lesion treated, tapering is common to ensure no recurrence of the lesion | ||
| - | * Monitor Blood pressure and pulse 1 and 2 hours after any dose increase of >0.5 mg/kg/day) | + | * Monitor Blood pressure and pulse 1 and 2 hours after any dose increase of >0.5 mg/kg/day |
| ==== Pre-Treatment issues ==== | ==== Pre-Treatment issues ==== | ||
| - | * Blood Pressure screening: [[infant_vital_signs|Normal Infant Vital Signs]] | + | * Blood Pressure |
| * Inappropriate Bradycardia | * Inappropriate Bradycardia | ||
| * Newborns (<1 month old) <70 BPM | * Newborns (<1 month old) <70 BPM | ||
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| * Rule out PHACES Syndrome: MRI/MRA Head and Neck, Echocardiogram | * Rule out PHACES Syndrome: MRI/MRA Head and Neck, Echocardiogram | ||
| * Cardiology consult if considering Propranolol in PHACES | * Cardiology consult if considering Propranolol in PHACES | ||
| + | |||
| + | === Screening for risks: === | ||
| + | * Cardiovascular and pulmonary history red flags | ||
| + | * History of: Poor feeding, dyspnea, tachypnea, diaphoresis, | ||
| + | * Exam needed: | ||
| + | * ECG if determined needed by above especially if: | ||
| + | * Newborns < 1 month old and pulse is < 70 BPM | ||
| + | * Infants 1-12 months old and pulse is < 80 BPM | ||
| + | * Children > 12 months and pulse is < 70 BPM | ||
| + | * Family history of congenital heart conditions or arrhythmias or maternal history of connective tissue disease | ||
| + | * Echocardiogram- not needed routinely | ||
| + | * PHACE syndrome (large segmental hemangioma of head neck, arterial anomalies of head and neck, congenital anomalies of brain, eyes and/or chest wall)- risk of ischemic stroke, needs to be managed by cardiology with neurology input | ||
| + | * if PHACE is suspected: MRI/ MRA of head and neck and Echocardiogram | ||
| + | * Slow titration up, lowest effective dosing, inpatient observation and TID dosing | ||
| + | === Protocol === | ||
| + | [[propranolol_for_hemangioma_protocol|See Outpatient Treatment of hemangioma with Propranolol Protocol]] | ||
| + | |||
| + | === Treatment Location === | ||
| + | * Inpatient for <8 weeks old or any age with inadequate social support or co-morbid conditions affecting the cardiovascular or respiratory system | ||
| + | * Outpatient for > 8 weeks old with good social support and no co-morbid conditions | ||
| + | |||
| + | |||
| ==== Adverse Effects ==== | ==== Adverse Effects ==== | ||
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| * Bradycardia- check pulse after dose change | * Bradycardia- check pulse after dose change | ||
| * [[infant_vital_signs|Infant Vital Signs]] | * [[infant_vital_signs|Infant Vital Signs]] | ||
| + | |||
| === Parents to call if...=== | === Parents to call if...=== | ||
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| =====Other Treatments===== | =====Other Treatments===== | ||
| - | |||
| - | |||
| * Surgical Excision | * Surgical Excision | ||
| + | |||
| ===== References ===== | ===== References ===== | ||
| - | * A Randomized, Controlled Trial of Oral Propranolol in Infantile Hemangioma {{: | + | |
| + | | ||
| + | * Initiation and Use of Propranolol for Infantile Hemangioma: Report of a Consensus Conference 2013{{http:// | ||
| {{tag> | {{tag> | ||