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Hemangioma Treatment

Propranolol

Dosing

  • 1 mg/kg/d divided TID or BID for 1 week
  • 2 mg/kg/d divided TID or BID for 1 week
  • 3 mg/kg/d divided TID or BID- keep at this dose (can increase with change in weight)
  • Minimum 6 hours between doses
  • Hold if child can't take PO
  • Child should not skip meals
  • Typically use for minimum 6 months
  • 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)

Pre-Treatment issues

  • Blood Pressure & Pulse screening: Normal Infant Vital Signs
  • Inappropriate Bradycardia
    • Newborns (<1 month old) <70 BPM
    • Infants (1-12 months old) <80 BPM
    • Children (>12 months old) <70 PBM
  • Inappropriate Systolic Blood Pressure (< 5th percentile for oscillometric or <2 SD below mean for auscultation)
    • Newborn: <57 mm Hg (oscillometric) or 64 mm Hg (auscultation)
    • 6 months: < 85 mm Hg (oscillometric) or 65 mm Hg (auscultation)
    • 1 year: <88 mm Hg (oscillometric) or 66 mm Hg (auscultation)
  • Rule out PHACES Syndrome: MRI/MRA Head and Neck, Echocardiogram
  • Cardiology consult if considering Propranolol in PHACES

Adverse Effects

  • Hypoglycemia- child should eat every 4 hours
  • Hypotension- check blood pressure after dose change
  • Bradycardia- check pulse after dose change
  • Infant Vital Signs

Parents to call if...

  • Lethargy
  • Cool Clammy skin
  • Breathing Difficulties

Intralesional Steroids

  • Triamcinolone 40mg/ml
  • Betamethasone 6mg/ml

Other Treatments

  • Surgical Excision

References

  • A Randomized, Controlled Trial of Oral Propranolol in Infantile Hemangioma PDF