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Pediatr Dermatol. 2015 Nov-Dec;32(6):802-7. doi: 10.1111/pde.12681. Epub 2015 Sep 22.

Blood Pressure Monitoring During the Induction and Maintenance Period of Propranolol Therapy for Complicated Infantile Hemangiomas: A Prospective Study of 109 Infants.

Author information

1
Department of Pediatrics, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany.
2
Department of Pediatric Dermatology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany.
3
Department of Pediatric Cardiology, Catholic Children's Hospital Wilhelmstift, Hamburg, Germany.

Abstract

BACKGROUND:

Propranolol has become the first-line treatment for complicated infantile hemangiomas (CIHs) worldwide. Recommendations for monitoring infants undergoing propranolol therapy vary. Data on long-term blood pressure (BP) monitoring have not been reported before.

OBJECTIVE:

The objective of the current study was to monitor BP in full-term infants during the induction and maintenance phase of propranolol therapy.

METHODS:

BP was monitored prospectively in 109 infants (mean age 2.8 mos, range 1-5 mos) with CIHs during the induction (3-4 days in the hospital during up-dosing from 0.5 to 2.0 mg/kg/day) and maintenance (6 mos) phases of oral propranolol therapy.

RESULTS:

Four children were excluded from the study because of sinus bradycardia (n = 2 [1.8%]) or lethargy (n = 2 [1.8%]). Mean systolic BP (SBP) decreased by 5 mmHg with the increase in propranolol dosage. Low (<5th percentile) SBP or diastolic BP (DBP) was observed in 2 of 105 children (1.9%) each. During the maintenance phase, 2 of 105 children (1.9%) had occasional SBP readings of less than 70 mmHg. No hypotension was observed after the third month of therapy. Low DBP (<36 mmHg) was recorded in 16 (15.2%) children after the first month, in 8.6% after the second, and in 2.9% during the third and fourth months of therapy. No patients exhibited clinical hypotension, bradycardia, or other known side effects of propranolol. Clinical response to therapy was excellent.

LIMITATIONS:

Reference BP values were derived from published tables, not from an untreated control group.

CONCLUSIONS:

In healthy full-term infants, propranolol (2 mg/kg/day divided in three doses) is well tolerated. No clinically significant hypotension was observed. We conclude that for otherwise healthy infants, BP monitoring during long-term propranolol therapy for CIHs is not necessary.

PMID:
26391729
DOI:
10.1111/pde.12681
[Indexed for MEDLINE]

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