Infantile Hemangiomas: A Tertiary Referral Center Institutional
Experience and Analysis of Propranolol Usage
Abstract
Introduction Oral propranolol is a first-line treatment for
infantile hemangiomas (IH). This study aims to describe the results of
treating IH with propranolol only or initial propranolol therapy
followed by laser therapy, surgical excision, corticosteroid therapy, or
a second cycle of propranolol. Methods Our patient population
included pediatric patients (<18 years of age) diagnosed with
IH at Monroe Carell Junior Children’s Hospital at Vanderbilt University
Medical Center between August 2009 to July 2017. Patient demographics,
IH clinical features, and treatment data were extracted from the
electronic medical record. Results Three hundred forty patients
with IH were included in this study, with a prevalence of focal lesions
(71%) and a total of 279 (82%) IH located on the head/neck. Lesions of
the head had a statistically significant association with PHACE syndrome
(p<0.001). Most patients initiated propanolol treatment before
the age of 6 months (71%), with continuation for ≥6 months (69%). Upon
discontinuation of propranolol, 14 (4%) patients required a second
cycle of propranolol for regrowth. After controlling for IH location,
patients with a family history of hemangiomas or cardiac abnormalities
were 3.6 times more likely to need a second round of propranolol
treatment (OR, 3.6; 95% Confidence Interval 1.14-11.19) (P=0.03).
Conclusion The study confirms propranolol’s effectiveness and
safety, reinforcing the need for early intervention and close monitoring
following treatment termination to prevent regrowth. Ultimately, this
research contributes to advancing the understanding and treatment of IH,
aiming to optimize patient outcomes and reduce morbidity.