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The Importance of Continuous Monitoring in Identifying Bradycardia during Propranolol Treatment for Infantile

Yasuhiko Maki1,2, Hiroyuki Iijima1, Kazue Yoshida3

  • 1Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.

JMA Journal
|February 12, 2026
PubMed

Insights

Continuous monitoring detects more bradycardia during propranolol treatment for infantile hemangioma (IH) than spot checks. Reducing propranolol dosage manages bradycardia effectively, ensuring positive IH outcomes.

Area of Science:

  • Pediatric cardiology
  • Dermatology
  • Pharmacology

Background:

  • Infantile hemangioma (IH) is a common vascular tumor in infants.
  • Propranolol is a first-line treatment for IH, but can cause bradycardia.
  • Current monitoring practices for propranolol-induced bradycardia vary.

Purpose of the Study:

  • To compare continuous monitoring versus spot measurement for detecting bradycardia during propranolol therapy for IH.
  • To explore management strategies for bradycardia in infants treated with propranolol.

Main Methods:

  • Retrospective study with historic controls (n=106) of infants (0-1 year) treated with propranolol for IH.
  • Comparison of spot-measurement group (n=49) vs. continuous-monitoring group (n=57).
  • Bradycardia defined as heart rate <90/min for 20 minutes; adverse events recorded.

Main Results:

  • Bradycardia occurred significantly more often in the continuous-monitoring group (21%) than the spot-measurement group (2%, p=0.003).
  • Two of 12 infants with bradycardia in the continuous-monitoring group were symptomatic.
  • All symptomatic infants improved with propranolol dose reduction, achieving favorable IH outcomes.

Conclusions:

  • Continuous monitoring is more sensitive for detecting bradycardia during propranolol treatment for IH.
  • Reducing propranolol dosage is an effective strategy to manage bradycardia while maintaining positive IH treatment outcomes.
Abstract

Keywords:
bradycardiainfantile hemangiomamonitoringpropranolol

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