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Propranolol in the management of airway infantile hemangiomas
Kristina W Rosbe1, Ki-Young Suh, Anna K Meyer
1Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, 2330 Post St, Ste 310, San Francisco, CA 94143-0342, USA. krosbe@ohns.ucsf.edu
Insights
Propranolol effectively managed airway infantile hemangiomas in infants with severe respiratory symptoms. This beta-blocker offered significant symptom reduction, enabling faster corticosteroid weaning.
Area of Science:
- Pediatric Otolaryngology
- Medical Genetics
- Pharmacology
Background:
- Airway infantile hemangiomas can cause life-threatening respiratory distress.
- Conventional treatments like corticosteroids and laser ablation have limitations.
Purpose of the Study:
- To evaluate the efficacy of propranolol in treating airway infantile hemangiomas.
- To assess propranolol's role in managing severe respiratory symptoms.
Main Methods:
- A case series of 3 infants with extensive, symptomatic airway infantile hemangiomas.
- Treatment involved propranolol, alone or in combination with corticosteroids.
Main Results:
- Propranolol led to significant reduction in subglottic airway obstruction and stridor.
- Two patients were successfully weaned off corticosteroids with propranolol therapy.
Conclusions:
- Propranolol is a valuable therapeutic option for airway infantile hemangiomas.
- It can be effective when other treatments fail or as part of a combined regimen.
Objective:
To report our experience with propranolol in managing airway infantile hemangiomas.
Design:
Case series of 3 consecutive patients who had extensive, symptomatic airway infantile hemangiomas treated with propranolol.
Setting:
Tertiary academic medical center.
Patients:
Three infants with facial cutaneous hemangiomas who developed stridor that progressed to respiratory distress, which according to laryngoscopic examination results was confirmed to be caused by extensive subglottic hemangiomas. These patients underwent follow-up during their course of therapy, ranging from 3 weeks to 15 months.
Results:
Patient 1 failed to respond to systemic corticosteroids, laser ablation, and intravenous vincristine for her airway hemangioma and had to undergo tracheotomy. She was given propranolol after her tracheotomy and had a significant reduction in her subglottic airway obstruction. Patient 2 developed progressive stridor secondary to airway hemangioma at age 6 1/2 months following tapering of systemic corticosteroids prescribed for her periorbital hemangioma. Systemic corticosteroids were restarted with the addition of propranolol. The stridor improved within 24 hours, and she was able to be weaned off corticosteroids. Patient 3 was also treated with initial combined therapy of systemic corticosteroids and propranolol. He had a significant reduction in stridor within 24 hours and was weaned off corticosteroids.
Conclusions:
Our 3 patients had severe respiratory symptoms related to their airway infantile hemangiomas. In the first patient, propranolol was used when other treatments were ineffective or associated with intolerable adverse effects. In the second and third patients, propranolol was part of a dual regimen that resulted in rapid resolution of airway symptoms and allowed for quicker weaning of corticosteroids.
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