CO 3 Effects and risks of beta-blocker in infantile haemangioma: A retrospective analysis

Introduction Infantile haemangioma (IH) is a very common vascular tumour that affects up to 10% of newborns. Since 2008, oral propranolol is used to treat complicated IH, like haemangioma that obstruct vital structures or ulcerated haemangioma. Objective The aim of this study was to investigate, by a retrospective review, the therapeutic results and effects of propranolol on cardiovascular and biological parameters in infants treated for complicated infantile haemangioma and to assess its safety. Results All paediatric patients with complicated IH who started systemic propranolol from February 2009 to December 2014 were included. 218 patients (155 girls and 63 boys) were treated by propranolol. The mean weight was 6780g (2115g to 20000g). Median age at beginning of treatment was 4.7 months (10 days to 6 years). The most frequent localisation of IH was facial (63 patients), palpebral (52 patients), perineal (20 patients), labial (14 patients), airway obstruction (8 patients) and 1 PHACE syndrome. Median length of therapy was 7.5 months for facial IH, 6 months for palpebral, 5.6 months for perineal IH and 7 months for subglottic localisation. Adverse events were observed: hypoglycemia (n=11 patients aged less 6 months), arterial hypotension (n=103 patients, especially at the second and third dose with dose titration), bradycardia (n=120). Transthoracic echocardiography was realised in 158 patients: 19 pathologies were found (8 PDA, 4 ASD, 4 mitral regurgitations, 2 VSD and 1 coarctation). Other adverse events occurred in 49 patients (wheezing, acrocyanosis, diarrhoea, sleep disturbance) leading to modification in management. Complete response was observed for all but 11 (partial or no response). Conclusion In appropriated patients, propranolol therapy is effective for severe or complicated IH. We must be aware of frequent adverse events under beta-blocker in these patients.