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Propranolol therapy for cutaneous infantile haemangiomas initiated safely as a day-case procedure
Edward McSwiney1, Deirdre Murray, Michelle Murphy
1Department of Paediatrics, Cork University Hospital, Cork, Ireland, dredwardmcswiney@gmail.com.
Insights
Initiating propranolol for infantile haemangiomas can be safely done on a day-case basis. This simplified protocol avoids routine cardiac investigations, reducing hospital stays for eligible patients.
Area of Science:
- Pediatric Dermatology
- Vascular Anomalies
- Pharmacology
Background:
- Infantile haemangiomas (IH) are common vascular tumors in infants.
- Propranolol is the leading treatment for high-risk IH.
- Current guidelines mandate overnight admission for propranolol initiation and baseline cardiac investigations (ECG, ECHO).
Purpose of the Study:
- To evaluate the safety and feasibility of a simplified day-case initiation protocol for propranolol in infantile haemangiomas.
- To assess the necessity of routine cardiac investigations for day-case propranolol initiation.
Main Methods:
- A prospective study of 20 consecutive infants with small to moderate IH.
- Day-case initiation of propranolol (0.5 mg/kg) with 2-hour observation.
- Targeted cardiac screening based on clinical examination; ECG/ECHO not routinely performed.
- Discharge on day 1 with dose escalation and day 8 review.
Main Results:
- No adverse reactions observed during day-case initiation or follow-up.
- All 20 patients were safely discharged on the same day.
- Routine cardiac investigations (ECG, ECHO) were not required for most patients.
- No serious adverse events were reported during the study period.
Conclusions:
- A simplified day-case protocol for propranolol initiation is safe and effective for small- to moderate-sized infantile haemangiomas.
- Targeted cardiac screening, rather than routine investigations, is sufficient for safe day-case initiation.
- This approach can reduce healthcare costs and improve patient convenience.
Abstract:
Propranolol is emerging as the treatment of choice for high-risk infantile haemangiomas. Current protocols recommend overnight admission for initiation of propranolol as well as baseline investigations including electrocardiography (ECG) and echocardiography (ECHO). Our study examined the safety profile of propranolol for the treatment of infantile haemangiomas using a simplified day-case initiation protocol. We evaluated 20 consecutive patients commencing propranolol as a day case for the treatment of an infantile haemangioma over an 18-month period. Investigations were carried out according to our local protocol. Cardiac investigations were not routinely performed. Patients were observed for 2 h following administration of the first dose of propranolol (0.5 mg/kg orally). If no adverse effects were observed, patients were discharged on a daily dose of propranolol of 1 mg/kg, increased to 2 mg/kg on day 4. Patients were reviewed on the day ward on day 8. All haemangiomas requiring treatment were small to moderate in size (median maximum diameter 2.35 cm). Except for capillary blood glucose measurement, no patient required venepuncture for additional blood investigations. As all patients had a normal clinical examination, none required ECHO. An ECG was performed on just one patient. No adverse reactions were observed following administration of propranolol. All patients were discharged home on the same day. No serious adverse events were reported at follow-up. We demonstrate that with targeted cardiac screening, propranolol can be safely initiated on a day-case basis for the treatment of small- to moderate-sized infantile haemangiomas.
