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Blood Pressure Monitoring During the Induction and Maintenance Period of Propranolol Therapy for Complicated Infantile Hemangiomas: A Prospective Study of 109 Infants
Author(s) -
Hengst Meike,
Oelert Monika,
Hoeger Peter H.
Publication year - 2015
Publication title -
pediatric dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.542
H-Index - 73
eISSN - 1525-1470
pISSN - 0736-8046
DOI - 10.1111/pde.12681
Subject(s) - medicine , propranolol , bradycardia , blood pressure , dosing , lethargy , sinus bradycardia , anesthesia , heart rate , maintenance therapy , pediatrics , surgery , chemotherapy
Background Propranolol has become the first‐line treatment for complicated infantile hemangiomas ( CIH s) worldwide. Recommendations for monitoring infants undergoing propranolol therapy vary. Data on long‐term blood pressure ( BP ) monitoring have not been reported before. Objective The objective of the current study was to monitor BP in full‐term infants during the induction and maintenance phase of propranolol therapy. Methods BP was monitored prospectively in 109 infants (mean age 2.8 mos, range 1–5 mos) with CIH s during the induction (3–4 days in the hospital during up‐dosing from 0.5 to 2.0 mg/kg/day) and maintenance (6 mos) phases of oral propranolol therapy. Results Four children were excluded from the study because of sinus bradycardia ( n = 2 [1.8%]) or lethargy ( n = 2 [1.8%]). Mean systolic BP ( SBP ) decreased by 5 mmHg with the increase in propranolol dosage. Low (<5th percentile) SBP or diastolic BP ( DBP ) was observed in 2 of 105 children (1.9%) each. During the maintenance phase, 2 of 105 children (1.9%) had occasional SBP readings of less than 70 mmHg. No hypotension was observed after the third month of therapy. Low DBP (<36 mmHg) was recorded in 16 (15.2%) children after the first month, in 8.6% after the second, and in 2.9% during the third and fourth months of therapy. No patients exhibited clinical hypotension, bradycardia, or other known side effects of propranolol. Clinical response to therapy was excellent. Limitations Reference BP values were derived from published tables, not from an untreated control group. Conclusions In healthy full‐term infants, propranolol (2 mg/kg/day divided in three doses) is well tolerated. No clinically significant hypotension was observed. We conclude that for otherwise healthy infants, BP monitoring during long‐term propranolol therapy for CIH s is not necessary.