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Propranolol therapy for hemangiomas in infants with neonatal abstinence syndrome may produce intolerable side effects

Joanna Twist1, Anthony Chen1, Paige Poffenberger1

  • 1School of Medicine, West Virginia University, Morgantown, West Virginia, USA.

Pediatric Dermatology
|February 18, 2022
PubMed

Insights

Infants treated for infantile hemangioma with propranolol experienced severe agitation and diarrhea. This may be linked to prior in utero opioid exposure causing increased beta-adrenergic receptor sensitivity.

Area of Science:

  • Pediatric pharmacology
  • Neonatal neuroscience
  • Pharmacogenetics

Background:

  • Infantile hemangiomas are common vascular tumors in infants.
  • Propranolol, a beta-adrenergic blocker, is the standard treatment.
  • Neonatal Abstinence Syndrome (NAS) is associated with in utero opioid exposure.

Observation:

  • Three infants with infantile hemangioma developed severe agitation and diarrhea after propranolol treatment.
  • All infants had a history of in utero opioid exposure and NAS.

Findings:

  • A potential link between in utero opioid exposure and adverse reactions to propranolol in infants is suggested.
  • Chronic opioid exposure may lead to upregulation of central nervous system beta-2 adrenergic receptors.

Implications:

  • This finding may inform clinical management of infants with infantile hemangioma and a history of NAS.
  • Further research is needed to elucidate the mechanisms of beta-adrenergic receptor sensitivity in this population.
  • Consideration of pre-existing conditions like NAS is crucial when initiating propranolol therapy.

Keywords:
dermatologyhemangiomaneonatal abstinence syndromepediatricspropranolol

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