| BACKGROUD AND OBJECTIVE:Infantile hemangioma is the most common congenital vascular tumor in childhood. Tumors can occur anywhere throughout the entire body, especially in head and neck. Usually, the tumor can go through three stages, including proliferative phase, involuting phase and involuted phase. Propranolol was firstly used in the treatment of infantile hemangioma in 2008 by French scientists, Leaute-Labreze C and now has become a first-line drugs for the treatment of infantile hemangioma since a large number of researches had proved its efficacy. However, dose and duration are still debated. Propranolol is in the recent new study highly lipophilic that it can make through the blood-brain barrier, which may lead to infant sleep and memory disorders and there may be a potential harm of neurodevelopment effects. This study, a retrospective review of one institution’s experience treating IH with propranolol using a standard protocol, aims to evaluate the efficacy and safety.RESEARCH METHODS:Between 2013 and 2015,68 patients with IH were evaluated for treatment with propranolol in Shandong provincial hospital. Exclusion criteria included a history of hypoglycemia, respiratory disorders, cardiovascular disorders, organ dysfunction and growth retardation. Monitor vital signs and take Denver developmental screening test before medication. Propranolol,1·1.5mg/(kg-d) was initiated during 48-hour inpatient with vital signs monitoring. Electrocardiogram, blood pressure, blood sugar and complications were monitored in every 4 weeks’follow-up. Appearance was assessed by the tumors size, surface tension and the change of color together with photoes and ultrasound data. Effects bases on the fading degree of IH are divided into significant response, partial response and no response. There is a Denver developmental screening test after complete treatment or 3-6 years’follow-up for children to evaluate whether propranolol affects development of the nervous system in children to complete safety assessment.RESULTS:Sixty-eight patients with eighty-three cutaneous lesions were treated with propranolol. Average age at initiation of therapy was 18.1 weeks. Average treatment duration was 13.4 months. The total efficiency rate was 96.4%, among them 29 (34.9%) the significant response,51 (61.4%) partially response and 3 cases (3.6%) no response. Lesions faded away and 2(2.4%) recurred in half a year after drug discontinuance. There is no statistical correlation found between efficiency rate and area of lesions as well as type of IH. There is negative significant correlation between efficiency rate and age of initial drug-using. Thirteen cases (19.1%) had side effects associated with drug. Diarrhea (n=6,8.8%), eczema (n=2,2.9%), poor sleep at night (n=1,1.5%), low blood sugar (n=1,1.5%), low blood pressure (n=1,1.5%), cold limb (n=1,1.5%), irritability (n=1,1.5%)were observed and 2 (2.9%) cases contain two of those side effects that could relieved after symptomatic treatment. There is no abnormality on vital signs of all children during the follow-up period. One doubtful case is screening out from the Denver development screening tests.CONCLUSION:The study present a series of patients with IH safely treated with a small dose (1-1.5 mg/kg, day) of propranolol. Using a strict protocol, curative effect is significant which can restrain the rapid growth of the hemangioma, promote to stable and faded, and shorten the natural course of the disease. Patients achieved significant reduction in size and improvement of the overall appearance of IH. The incidence of adverse reactions is low. There is no harmful effect detected to nervous system development of patients long-term after therapy. Propranolol can be used as one of the first-line drugs for the treatment of infantile hemangioma. |
PDF Full Text Request