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TREATMENT OF PROBLEMATIC PROLIFERATING HAEMANGIOMA WITH PROPRANOLOL
Author(s) -
Ngan N. C.,
Tan S. T.,
Leadbitter P.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04927_53.x
Subject(s) - medicine , propranolol , postprandial , regimen , lesion , nose , blood pressure , surgery , anesthesia , insulin
Aims: The mainstay treatment for problematic proliferating haemangioma is pharmacologic with high dose steroid being the first line treatment. A dramatic response occurs in 30% of cases, equivocal in 40% and continued growth is observed in the remainder cases. Steroid therapy is associated with significant side effects. We report our experience in treating proliferating haemangioma with Propranolol, discovered serendipitously by Léauté‐Labràze et al recently. Methodology: A 9‐week old boy was referred with a steroid‐resistant proliferating haemangioma involving the upper lip and nose causing feeding and breathing difficulties. The patient was commenced on Propranolol at 0.5 mg/kg twice daily for 24 hours increasing to 1 mg/kg twice daily. The treatment was administered as an inpatient with 4‐hourly heart rate and blood pressure and postprandial (30 minutes) blood glucose level monitoring, for the first 48 hours. The second patient was a 3‐month old boy with a similar rapidly proliferating lesion on the upper lip and nose. He was commenced on similar Propranolol regimen. Both patients were maintained on the original total daily dose of Propranolol. Results: In both cases rapid reduction of the size and softening of the lesion was noted within 48 hours of treatment with on going accelerated regression observed during the follow‐up period of 4 and 2 months respectively. No cardiovascular or metabolic side effects were observed in both patients. Conclusion: Accelerated regression is observed in 2 infants with problematic haemangioma following Propranolol therapy with no observed side effect. The possible mechanism of action of beta‐blocker on cell proliferation is discussed.