From the Guidelines
The starting dose of propranolol for infants is 1 mg kg-1 daily in three divided doses, according to the British Society for Paediatric Dermatology consensus guidelines 1. This dose can be increased after 24 hours to 2 mg kg-1 daily in three divided doses. However, for preterm patients and those with comorbidities, the starting dose may need to be modified to 0.5 mg kg-1 daily. Key considerations for initiating propranolol in infants include:
- Age: Infants older than 4 weeks can be initiated on an outpatient basis without monitoring of heart rate or blood pressure, if they have no significant comorbidities and are born at term with normal birth weight and established feeds 1.
- Comorbidities: Preterm patients and those with conditions such as hyperinsulinism, previous episodes of hypoglycaemia, respiratory, cardiac, metabolic, and neurological disorders may require a modified starting dose and closer monitoring 1.
- Feeding: Parents should ensure their child is fed regularly to reduce the risk of hypoglycaemia, and propranolol should be stopped if feeding is reduced due to illness 1.
- Monitoring: Heart rate, blood pressure, and blood glucose levels should be closely monitored during initiation and dose adjustments, particularly for high-risk patients 1.
From the Research
Propranolol Starting Dose for Infants
- The starting dose of propranolol for infants with infantile hemangiomas is typically 2 mg/kg/day, as reported in a study published in the European journal of pediatrics 2.
- Another study published in The Laryngoscope also used a dose of 2 mg/kg/day for infants with problematic hemangiomas 3.
- A more recent study published in Journal of vascular anomalies suggested that a dose of 1 mg/kg/dose, administered 2-3 times daily, is commonly used for infants with infantile hemangiomas 4.
- However, the same study also explored the effect of administering R(+) propranolol once a day at a dose of 1 × 25 mg/kg/day, which was found to be sufficient to block vasculogenesis in a xenograft model of infantile hemangioma 4.
Administration and Monitoring
- Propranolol initiation protocols may vary depending on the institution, and some patients may require inpatient monitoring, especially those with a history of premature birth or low weight 5.
- A study published in Pediatric dermatology found that propranolol initiation is safe in pediatric patients, with significant decreases in blood pressure and heart rate, but no symptomatic hypoglycemia or clinically meaningful differences in vital sign alterations between different patient populations 5.
- Another study published in The Journal of pediatrics used a liquid form of propranolol (10 mg/ml) to administer doses of 0.5 to 4.0 mg/kg/day to infants and children, and found it to be effective and well-tolerated 6.