Oral Propranolol for Infantile Hemangioma:

The New Treatment of Choice?

In a randomized controlled trial, oral propranolol abruptly stopped hemangioma growth in infants and children younger than 5 years.
Infantile hemangiomas are vascular tumors that affect about 5% of infants. Although most lesions will spontaneously involute, some lesions can create life-threatening or functional complications because of their location. In a randomized placebo-controlled trial, researchers evaluated the efficacy and safety of oral propranolol (titrated to a maximum dose of 2 mg/kg divided in 3 doses daily for 6 months) in 40 children (age range, 9 weeks to 5 years) at imminent or time-sensitive risk for complications of infantile hemangiomas.
All children were followed closely for adverse effects and response to therapy, and children younger than 6 months were admitted to and monitored in the hospital after the first doses at weeks 1 and 2. Hemangioma growth abruptly stopped by week 4 in all patients in the propranolol group, and the difference between groups in percent change in volume was significant throughout the study. On the basis of blinded investigator scores of photographs, the propranolol group had significantly less hemangioma redness and elevation at weeks 12 and 24, compared with the placebo group. Treatment was well tolerated with no reported episodes of hypotension, bradycardia, or hypoglycemia.
Comment: Since the serendipitous observation that propranolol induced involution of infantile hemangiomas was made 3 years ago, β-blocker therapy is rapidly becoming the first-line treatment. At The Children's Hospital of Philadelphia, we also admit infants younger than 6 months to begin oral therapy. The rapid onset of action is remarkable. Be aware that protocols for escalating therapy differ by institution. Therefore, early referral to a pediatric dermatologist for concerning hemangiomas is important, because early treatment is associated with the best outcomes. Contraindications to propranolol include wheezing and PHACE syndrome.
- Louis M. Bell, MD
Published in Journal Watch Pediatrics and Adolescent Medicine September 7, 2011

A campaign recently launched Autism Case Training - A Developmental-Behavioral Pediatrics Curriculum (ACT) at the 2011 AAP National Conference and Exhibition . The AAP-endorsed curriculum is designed to educate future pediatricians on identifying, diagnosing, and managing autism spectrum disorders through case-based scenarios.  The curriculum is a flexible, interactive learning tool that emphasizes practical skills for patient and parent interaction. Facilitators and learners are supported with a suite of materials to enhance their experience.  ACT consists of 7 case-based studies that can be taught individually or as part of a series.  Currently in development is a self-guided, web-based CME module. The module will help practicing healthcare professionals update their knowledge, learn best practice, and earn CME credit.  

To download the complete ACT materials visit www.cdc.gov/AutismCaseTraining.   

For additional information, email ActEarly@cdc.gov.

To learn more about autism spectrum disorders from the AAP, visit www.medicalhomeinfo.org/about/cocwd/autism.aspx.