Initiation and Use of Propranolol for Infantile Hemangioma: Report of a Consensus Conference
Beth A. Drolet,Peter C. Frommelt,Sarah L. Chamlin,Anita N. Haggstrom,Nancy M. Bauman,Yvonne E. Chiu,Robert H. Chun,Maria C. Garzon,Kristen E. Holland,Leonardo Liberman,Susan G. MacLellan-Tobert,Anthony J. Mancini,Denise W. Metry,Katherine B. Puttgen,Marcia Seefeldt,Robert Sidbury,Kendra M. Ward,Francine Blei,Eulalia Baselga,Laura D. Cassidy,David H. Darrow,Shawna Joachim,Eun Kyung M. Kwon,Kari Martin,Jonathan A. Perkins,Dawn H. Siegel,Robert J. Boucek,Ilona J. Frieden +27 more
TLDR
The multidisciplinary team agreed on a number of recommendations that arose from a review of existing evidence, including when to treat complicated IH; contraindications and pretreatment evaluation protocols; propranolol use in PHACE syndrome; formulation, target dose, and frequency of proPRanolol; initiation of propr ethanol in infants; cardiovascular monitoring; ongoing monitoring; and prevention of hypoglycemia.Abstract:
Infantile hemangiomas (IHs) are common neoplasms composed of proliferating endothelial-like cells. Despite the relative frequency of IH and the potential severity of complications, there are currently no uniform guidelines for treatment. Although propranolol has rapidly been adopted, there is significant uncertainty and divergence of opinion regarding safety monitoring, dose escalation, and its use in PHACE syndrome (PHACE = posterior fossa, hemangioma, arterial lesions, cardiac abnormalities, eye abnormalities; a cutaneous neurovascular syndrome characterized by large, segmental hemangiomas of the head and neck along with congenital anomalies of the brain, heart, eyes and/or chest wall). A consensus conference was held on December 9, 2011. The multidisciplinary team reviewed existing data on the pharmacologic properties of propranolol and all published reports pertaining to the use of propranolol in pediatric patients. Workgroups were assigned specific topics to propose protocols on the following subjects: contraindications, special populations, pretreatment evaluation, dose escalation, and monitoring. Consensus protocols were recorded during the meeting and refined after the meeting. When appropriate, protocol clarifications and revision were made and agreed upon by the group via teleconference. Because of the absence of high-quality clinical research data, evidence-based recommendations are not possible at present. However, the team agreed on a number of recommendations that arose from a review of existing evidence, including when to treat complicated IH; contraindications and pretreatment evaluation protocols; propranolol use in PHACE syndrome; formulation, target dose, and frequency of propranolol; initiation of propranolol in infants; cardiovascular monitoring; ongoing monitoring; and prevention of hypoglycemia. Where there was considerable controversy, the more conservative approach was selected. We acknowledge that the recommendations are conservative in nature and anticipate that they will be revised as more data are made available.read more
Citations
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Journal ArticleDOI
A Randomized, Controlled Trial of Oral Propranolol in Infantile Hemangioma
Christine Léauté-Labrèze,Peter H. Hoeger,Juliette Mazereeuw-Hautier,Laurent Guibaud,Eulalia Baselga,Gintas Posiunas,Roderic J Phillips,Héctor Cáceres,Juan Carlos López Gutiérrez,Rosalia Ballona,Sheila Fallon Friedlander,Julie Powell,Danuta Perek,Brandie J. Metz,Sébastien Barbarot,Annabel Maruani,Zsuzsanna Szalai,Alfons Krol,Olivia Boccara,Regina Foelster-Holst,María Isabel Febrer Bosch,John C Su,Hana Buckova,Antonio Torrelo,Frédéric Cambazard,Rainer Grantzow,Orli Wargon,Dariusz Wyrzykowski,Jochen Roessler,Jose Bernabeu-Wittel,Adriana M Valencia,Przemysław Przewratil,Sharon A. Glick,Elena Pope,Nicholas Birchall,Latanya Benjamin,Anthony J. Mancini,Pierre Vabres,Pierre Souteyrand,Ilona J. Frieden,Charles I Berul,Cyrus R. Mehta,Sorilla Prey,Franck Boralevi,Caroline C. Morgan,Stephane Heritier,Alain Delarue,Jean-Jacques Voisard +47 more
TL;DR: This trial showed that propranolol was effective at a dose of 3 mg per kilogram per day for 6 months in the treatment of infantile hemangioma.
Journal ArticleDOI
Clinical Practice Guideline for the Management of Infantile Hemangiomas.
Daniel P. Krowchuk,Ilona J. Frieden,Anthony J. Mancini,David H. Darrow,Francine Blei,Arin K. Greene,Aparna Annam,Cynthia N. Baker,Peter C. Frommelt,Amy Hodak,Brian M. Pate,Janice L. Pelletier,Deborah Sandrock,Stuart T. Weinberg,Mary Anne Whelan +14 more
TL;DR: This clinical practice guideline for the management of infantile hemangiomas discusses the specific growth characteristics of IHs, that is, that the most rapid and significant growth occurs between 1 and 3 months of age and that growth is completed by 5 month of age in most cases.
Journal ArticleDOI
Diagnosis and Management of Infantile Hemangioma.
TL;DR: This clinical report is the first based on input from individuals representing the many specialties involved in the treatment of IH to update the pediatric community regarding recent discoveries in IH pathogenesis, treatment, and clinical associations and to provide a basis for clinical decision-making in the management of Ih.
Journal ArticleDOI
Treatment of infantile haemangiomas: recommendations of a European expert group.
Peter H. Hoeger,John I. Harper,Eulalia Baselga,Damien Bonnet,Laurence M. Boon,Marta Ciofi Degli Atti,Maya El Hachem,Arnold P. Oranje,Agneta Troilius Rubin,Lisa Weibel,Christine Léauté-Labrèze +10 more
TL;DR: Oral propranolol is the first-line agent for the treatment of complicated IH after an international, interdisciplinary team of experts recommended it based on an up-to-date review of the literature.
Journal ArticleDOI
Safety of Oral Propranolol for the Treatment of Infantile Hemangioma: A Systematic Review
Christine Léauté-Labrèze,Olivia Boccara,Caroline Degrugillier-Chopinet,Juliette Mazereeuw-Hautier,Sorilla Prey,Geneviève Lebbé,Stéphanie Gautier,Valérie Ortis,Martine Lafon,Agnès Montagne,Alain Delarue,Jean-Jacques Voisard +11 more
TL;DR: Oral propranolol is well tolerated if appropriate pretreatment assessments and within-treatment monitoring are performed to exclude patients with contraindications and to minimize serious side effects during treatment.
References
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The Agency for Healthcare Research and Quality
TL;DR: The mission of the Agency for Healthcare Research and Quality is “to improve the quality, safety, efficiency, and effectiveness of health care for all Americans”.
Journal ArticleDOI
Propranolol for Severe Hemangiomas of Infancy
Christine Léauté-Labrèze,Dumas de la Roque E,Thomas Hubiche,Franck Boralevi,Thambo Jb,Alain Taieb +5 more
TL;DR: It is observed in 11 children that propranolol can inhibit the growth of infantile capillary hemangiomas and this work is hopeful that this discovery will help improve the prognosis of these patients.
Journal ArticleDOI
PHACE Syndrome: The Association of Posterior Fossa Brain Malformations, Hemangiomas, Arterial Anomalies, Coarctation of the Aorta and Cardiac Defects, and Eye Abnormalities
TL;DR: The acronym PHACE syndrome is proposed to emphasize the characteristic findings of this neurocutaneous syndrome: posterior fossa malformations, hemangiomas, arterial anomalies, coarctation of the aorta and cardiac defects, and eye abnormalities.
Journal ArticleDOI
Propranolol for Severe Infantile Hemangiomas: Follow-Up Report
Veronique Sans,Eric Dumas De La Roque,Jérôme Berge,Nicolas Grenier,Franck Boralevi,Juliette Mazereeuw-Hautier,Dan Lipsker,Elisabeth Dupuis,Khaled Ezzedine,P. Vergnes,Alain Taieb,Christine Léauté-Labrèze +11 more
TL;DR: Propranolol administered orally at 2 to 3 mg/kg per day has a consistent, rapid, therapeutic effect, leading to considerable shortening of the natural course of IHs, with good clinical tolerance.
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