Long-term neurocognitive functioning of children treated with propranolol or atenolol for infantile hemangioma
Mireille M Hermans1, André B Rietman2, Renske Schappin1,3
1Department of Dermatology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, member of the ERN-SKIN-Mosaic group and ERN-VASCERN-VASCA group, Rotterdam, Netherlands.
Insights
Long-term neurocognitive outcomes were similar in children treated with propranolol or atenolol for infantile hemangioma. Both beta-blockers appear safe for cognitive development, though males showed lower scores.
Area of Science:
- Pediatric pharmacology
- Neurodevelopmental outcomes
- Infantile hemangioma treatment
Background:
- Infantile hemangioma (IH) is effectively treated with propranolol or atenolol.
- Concerns exist regarding potential long-term neurocognitive effects of these beta-blockers.
Purpose of the Study:
- To compare long-term neurocognitive functioning in children treated with propranolol versus atenolol for IH.
- To assess working memory, processing speed, and attention in children aged 6 years and older.
Main Methods:
- Cross-sectional study of 105 children (36 propranolol, 69 atenolol) aged 6+ years.
- Primary outcome: Wechsler Intelligence Scale for Children-V Cognitive Proficiency Index (CPI).
- Secondary outcomes included general intelligence, memory, and executive functioning.
Main Results:
- No significant differences in CPI or other neurocognitive outcomes between propranolol and atenolol groups.
- All outcomes were comparable to general population norms.
- Males exhibited significantly lower CPI scores than females and population norms.
Conclusions:
- Propranolol and atenolol demonstrate comparable safety for long-term neurocognitive functioning in children treated for IH.
- Lower neurocognitive scores in males warrant further investigation and consideration in risk-benefit assessments.
Abstract:
The purpose of this study was to compare long-term neurocognitive functioning (working memory, processing speed, and attention) between children who had been treated with either propranolol or atenolol for infantile hemangioma during infancy. All eligible children (n = 158) aged 6 years or older and treated with propranolol or atenolol as infants were invited to participate in this two-center cross-sectional study. The primary outcome was the Wechsler Intelligence Scale for Children-V Cognitive Proficiency Index (CPI), a measure of working memory, processing speed, and attention. Secondary outcomes were general intelligence, auditory, visuospatial, and narrative memory, as well as executive functioning and sleep. A total of 105 children, of whom 36 had been treated with propranolol (age 6.0-11.8 years, follow-up time 1.6-9.7 years, 19% male) and 69 had been treated with atenolol (age 6.9-9.7 years, follow-up time 4.5-8.4 years, 19% male), were analyzed. The CPI and other neurocognitive outcomes did not differ between the propranolol and atenolol groups and were in line with general population test norms. Post hoc analyses revealed lower CPI scores for males, both compared to participating females (10.3 IQ points, medium effect size) and compared to matched test norms (12.4 IQ points, medium effect size).
Conclusions:
Long-term neurocognitive functioning did not differ between children treated with propranolol and those treated with atenolol for IH. Overall, propranolol and atenolol appear to be safe treatments for IH regarding long-term neurocognitive functioning. The substantially lower CPI scores in males warrant further investigation.
Trial Registration:
Netherlands Trial Register, NL7703 https://www.trialregister.nl/trial/7703 What is Known: • Infants with infantile hemangioma are effectively treated with propranolol or atenolol. • Parents and professionals are concerned about long-term neurocognitive effects.
What Is New:
• No long-term (≥ 6 years) differences in neurocognitive functioning were found between children treated with propranolol or atenolol. • Males treated with beta-blockers had substantially lower IQ scores than treated females and males from the general population, which is a matter of concern and should be considered when evaluating the risk/benefit ratio in less severe forms of infantile hemangioma.
