From the Guidelines
Propranolol is not indicated for the treatment of congenital hemangiomas. Unlike infantile hemangiomas, congenital hemangiomas are fully formed at birth and have a different biological makeup that does not respond to beta-blocker therapy 1. Congenital hemangiomas are classified into three types: rapidly involuting congenital hemangioma (RICH), non-involuting congenital hemangioma (NICH), and partially involuting congenital hemangioma (PICH). These lesions have different natural histories and management approaches. RICH lesions typically regress on their own within the first year of life without treatment, while NICH lesions persist and may require surgical intervention if they cause functional impairment or significant cosmetic concerns. The lack of response to propranolol in congenital hemangiomas is due to their different pathophysiology compared to infantile hemangiomas, particularly regarding their expression of glucose transporter protein-1 (GLUT-1) and their completed growth cycle at birth. Management of congenital hemangiomas typically involves observation for RICH lesions and possible surgical excision for NICH or PICH lesions that cause complications.
Some key points to consider in the management of congenital hemangiomas include:
- The classification of congenital hemangiomas into RICH, NICH, and PICH types, each with distinct natural histories and management approaches 1
- The role of observation versus surgical intervention in the management of congenital hemangiomas, depending on the type and presence of complications 1
- The importance of considering the potential risks and benefits of treatment, including the use of propranolol, in the management of congenital hemangiomas 1
- The need for individualized treatment plans, taking into account the unique characteristics and needs of each patient with a congenital hemangioma 1
Overall, the management of congenital hemangiomas requires a thoughtful and multidisciplinary approach, taking into account the latest evidence and guidelines. Propranolol is not a recommended treatment for congenital hemangiomas, and other management strategies should be considered on a case-by-case basis.
From the Research
Indication of Propranolol in Congenital Hemangioma Treatment
- Propranolol is indicated in the treatment of congenital hemangioma, specifically infantile hemangiomas (IHs) 2, 3, 4, 5, 6.
- The effectiveness of propranolol in treating IHs has been demonstrated in several studies, with significant reductions in size and extent of the hemangiomas observed within a few weeks of treatment initiation 2, 5, 6.
- Propranolol has been shown to be safe and well-tolerated in infants, including those less than five weeks corrected age, with mild side effects such as sleep disturbance, irritability, and cool hands/feet reported in some cases 4, 5.
Dosage and Administration
- The recommended dosage of propranolol for IH treatment is 1-3 mg/kg/day, with gradual increase in dosage over a period of 1-2 weeks 2, 5.
- Propranolol can be administered orally, and outpatient treatment has been shown to be effective and safe 5.
Efficacy and Safety
- Propranolol has been shown to be highly effective in treating IHs, with excellent response rates observed in several studies 2, 5, 6.
- The safety profile of propranolol in IH treatment is generally favorable, with mild side effects reported in some cases, and no serious adverse events observed in several studies 2, 4, 5, 6.
- However, close monitoring of serum electrolytes, hemodynamics, and blood glucose is necessary, especially during the initial phase of treatment, due to the risk of hyperkalemia and other adverse effects 3.