Oral propranolol and its impact on vital signs in hospitalized pediatric patients for the Management of Infantile Hemangiomas

Abstract

Background: Infantile hemangiomas (IH) affect 2%–10% of the pediatric population. The current standard treatment for complicated IH is oral propranolol. Propranolol initiation protocols vary depending on institution and may occur in an inpatient setting for patients <5-week-corrected-age, with a history of premature birth, and or with low weight to allow for heart rate (HR), blood pressure (BP), and glucose monitoring. Objective: Our study aimed to determine the clinical outcomes of monitoring inpatient propranolol initiation and to evaluate if complications occurred during admission. Methods: Retrospective chart review of patients seen at the University of Minnesota Department of Dermatology between January 01, 2012 and July 31, 2022 was completed. Inclusion criteria include less than 1 year of age at time of admission, a diagnosis of IH and or PHACE syndrome, and admission for propranolol initiation and monitoring. Results: Admissions for 78 pediatric patients were reviewed. After initiation of propranolol, significant decreases in BP (systolic p =.005; diastolic p =.002) and HR (p =.004) were noted; however, average BPs and HRs remained above the lower limit of normal. No patients experienced symptomatic hypoglycemia. No statistically significant or clinically meaningful differences in vital sign alterations were observed between patients <5 versus >5 kg; preterm vs term gestation; or <5-week-corrected-age versus >5-week-corrected-age. Discussion: Our findings complement current literature confirming that propranolol initiation is safe in pediatric patients. Propranolol initiation likely requires less laboratory and vital sign monitoring than currently performed for these patient populations.