Propranolol Treatment in Infantile Hemangiomas: A Single Center Experience

Yıl 2023, , 84 - 88, 27.03.2023

Şeyma Karatekin , Ali Ayçiçek , Müge Gündoğdu Hüseyin Aldemir

https://doi.org/10.26650/jchild.2023.1116362

Öz

Objective: Infantile hemangioma (IH) is the most common benign vascular tumor in infants. Although most IHs regress spontaneously, complicated IHs require treatment. Currently, propranolol has become the first-line therapy for managing IH. This study aims to evaluate patients who’ve been hospitalized and started propranolol treatment in order to assess how to follow the treatment process as well as the effectiveness and safety of the treatment in light of the current literature. Materials and Methods: 48 patients who were hospitalized for IH and started propranolol treatment between June 2012 and December 2015 were evaluated retrospectively. The cases were examined in terms of pre-treatment laboratory tests, cardiological evaluation, imaging methods, age, gender, hemangioma location, treatment indication, side effects and treatment efficacy. Results: The mean age of starting treatment was 6 months (range=2-146 months) in the total of 48 cases (nfemale=32, nmale=16), with 30% of the cases having a history of preterm delivery. No pathology was detected in 38 (90%) of the 42 patients who’d been assessed using cranial USG before treatment. Corpus callosum agenesis was detected in one patient, hydrocephalus in one patient, and choroid plexus cyst in one patient. Abdominal ultrasonography were normal in 89% of the 47 assessed patients, renal agenesis was found in one patient, and hepatic hemangiomas were detected in four patients (9%). Indications for treatment were rapid growth (44%), ulcerated hemangioma (29%), and giant hemangioma (27%). Mean duration of treatment was 15.3±7.9 months. Duration of treatment in giant hemangiomas was significantly longer compared to the other indications (p<0.05). According to clinical evaluation, propranolol treatment was found to be effective in 88% of patients. No life-threatening side effects were observed. Bradycardia and arrhythmia were detected in two patients, but treatment was continued as they resolved spontaneously. Conclusion: Propranolol treatment was found to be effective and safe for treating infantile hemangioma. In patients with a normal physical examination and no risk regarding anamnesis, initiating treatment under surveillance at hospital and evaluating routine ECG and ECO before treatment might not be absolutely necessary.

Anahtar Kelimeler

Hemangioma, infant, propranolol, side effects

İnfantil Hemanjiomlarda Propranolol Tedavisi: Tek Merkez Deneyimi

Öz

Amaç: İnfantil hemanjiom (İH), infantların en sık benign vasküler tümörüdür. Çoğu İH kendiliğinden gerilemesine rağmen, komplike İH’lar tedavi gerektirir. Günümüzde, propranolol İH yönetiminde birinci basamak tedavi olmuştur. Hastanede yatırılarak propranolol tedavisi başlanan olguları, tedavi sürecinde yapılması / yapılmaması gerekenleri, tedavi etkinliği ve güvenilirliğini güncel literatür eşliğinde değerlendirmeyi amaçladık. Gereç ve Yöntem: Haziran 2012 - Aralık 2015 tarihlerinde İH nedeniyle hastanede yatırılarak propranolol tedavisi başlanmış 48 olgu retrospektif olarak değerlendirildi. Olgular tedavi öncesi laboratuvar tetkikleri, kardiyolojik değerlendirme, görüntüleme yöntemleri, yaş, cins, hemanjiom yeri, tedavi endikasyonu, yan etki ve tedavi etkinliği açısından incelendi. Bulgular: Kırk sekiz olgunun (K:32, E:16), tedaviye başlama yaşı median 6 ay (2-146 ay) olup, olguların %30’u prematüre doğum öyküsüne sahipti. Tedavi öncesinde transfontanel USG yapılan 42 hastanın 38’inde (%90) patoloji saptanmadı. Hastalardan birinde corpus kallosum agenezisi, bir hastada hidrosefali, bir hastada koroid pleksus kisti saptandı. Batın USG ile değerlendirilen 47 hastadan 42’sinde (%89) sonuçlar normaldi, bir hastada renal agenezi, 4 hastada (%9) karaciğerde hemanjiom mevcuttu. Tedavi endikasyonu sırasıyla hızlı büyüme (%44), ülsere hemanjiom (%29) ve dev hemanjiomdu (%27). Ortalama tedavi süresi 15.3(±7.9) ay bulundu. Dev hemanjiomlardaki tedavi süresi, diğer endikasyonlardaki tedavi sürelerinden uzundu (p<0,05). Klinik değerlendirmeye göre hastaların %88’sinde propranolol tedavisi etkili bulundu. Hayatı tehdit eden bir yan etki görülmedi. Hastalardan 2’sinde bradikardi ve disritmi tespit edildi, ancak spontan düzeldiği için tedaviye devam edildi. Sonuç: Propranolol tedavisi infantil hemanjiom tedavisinde etkili ve güvenilir bulunmuştur. Araştırmamız, fizik muayenesi normal olan , anamnezinde herhangi bir risk tespit edilemeyen hastalarda tedavi öncesi rutin EKG, EKO değerlendirmesinin ve tedavinin yatırılarak gözetim altında başlanmasının mutlak gerekli olmadığını düşündürmektedir.

Anahtar Kelimeler

Hemanjiom, bebek, propranolol, yan etkiler

Kaynakça

• 1. Kim JH, Lam JM. Paediatrics: how to manage infantile haemangioma. Drugs in Context 2021;10:12-6. google scholar
• 2. Krowchuk DP, Frieden IJ, Mancini AJ, Darrow DH, Blei F, Greene AK, et al. Clinical practice guideline for the management of infantile hemangiomas. Pediatrics 2019;143(1). google scholar
• 3. Léauté-Labrèze C, De La Roque ED, Hubiche T, Boralevi F, Thambo J-B, Taïeb A. Propranolol for severe hemangiomas of infancy. New England Journal of Medicine 2008;358(24):2649-51. google scholar
• 4. Hoeger PH, Harper JI, Baselga E, Bonnet D, Boon LM, Atti MCD, et al. Treatment of infantile haemangiomas: recommendations of a European expert group. European Journal of Pediatrics 2015;174(7):855-65. google scholar
• 5. Marqueling AL, Oza V, Frieden IJ, Puttgen KB. Propranolol and infantile hemangiomas four years later: a systematic review. Pediatric dermatology 2013;30(2):182-91. google scholar
• 6. Yang H, Hu D-L, Shu Q, Guo X-D. Efficacy and adverse effects of oral propranolol in infantile hemangioma: a meta-analysis of comparative studies. World Journal of Pediatrics 2019;15(6):546-58. google scholar
• 7. Leaute-Labreze C, Hoeger P, Mazereeuw-Hautier J, Guibaud L, Baselga E, Posiunas G, et al. A randomized, controlled trial of oral propranolol in infantile hemangioma. N Engl J Med 2015;372:735-46. google scholar
• 8. Özcan R, Aktemur S, Emre Ş, Adaletli İ, Erdoğan E, Tekant GT. Oral Propranolol Administration in Treatment of Hemangiomas: An Update Hemanjiom Tedavisinde Oral Propranolol Kullanımı Sonuçlarımız: Güncelleme. İstanbul Medical Journal 2017;18:227-31. google scholar
• 9. Prey S, Voisard J-J, Delarue A, Lebbe G, Taieb A, Leaute-Labreze C, et al. Safety of propranolol therapy for severe infantile hemangioma. Jama 2016;315(4):413-5. google scholar
• 10. Wu HW, Wang X, Zhang L, Zheng JW, Liu C, Wang YA. Topical timolol vs. oral propranolol for the treatment of superficial infantile hemangiomas. Frontiers in Oncology 2018;8:605. google scholar
• 11. Giachetti A, Garcia-Monaco R, Sojo M, Scacchi MF, Cernadas C, Guerchicoff Lemcke M, et al. Long-Term Treatment with Oral Propranolol Reduces Relapses of Infantile Hemangiomas. Pediatric Dermatology 2014;31(1):14-20. google scholar
• 12. Yüksel H, Yasar A, Gürbüz N, Bizbirlik ZI, Yilmaz Ö. Infantile Glottic Hemangioma: Bronchoscopic Evaluation and Propranolol Treatment. Journal of Bronchology & Interventional Pulmonology 2021;28(4):e69-e73. google scholar
• 13. Nisipasu CI, Plesca D, Stancea I, Nisipasu C, Spataru R. Problematic Periocular Hmenagiomas-Same Treatment, Different Outcomes. Jurnalul Pediatrului 2014;17:67-8. google scholar
• 14. Ayvaz OD, Gül C, Orbay MT, Tılev SM, Celayır A. The Relationship of Propranolol Treatment Success with the Location of Hemangioma and Patient Age: A Retrospective Study. Türkiye Klinikleri Tip Bilimleri Dergisi 2021;41(3):197-204. google scholar
• 15. Bandera AIR, Sebaratnam DF, Wargon O, Wong L-CF. Infantile hemangioma. Part 1: Epidemiology, pathogenesis, clinical presentation and assessment. Journal of the American Academy of Dermatology 2021;85(6):1379-92. google scholar
• 16. Leaute-Labreze C, Harper JI, Hoeger PH. Infantile haemangioma. The Lancet 2017;390(10089):85-94. google scholar
• 17. Yang H, Hu D-L, Shu Q, Guo X-D. Efficacy and adverse effects of oral propranolol in infantile hemangioma: a meta-analysis of comparative studies. Springer Singapore 2019;15(6):546-58. google scholar