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Great Ormond Street Hospital treatment guidelines for use of propranolol in infantile isolated subglottic haemangioma

Published online by Cambridge University Press:  01 February 2013

Y Bajaj ,
K Kapoor ,
S Ifeacho ,
C G Jephson ,
D M Albert ,
J I Harper  and
B E Hartley
Y Bajaj*
Affiliation:
Department of ENT, Great Ormond Street Hospital, London, UK
K Kapoor
Affiliation:
Department of ENT, Great Ormond Street Hospital, London, UK
S Ifeacho
Affiliation:
Department of ENT, Great Ormond Street Hospital, London, UK
C G Jephson
Affiliation:
Department of ENT, Great Ormond Street Hospital, London, UK
D M Albert
Affiliation:
Department of ENT, Great Ormond Street Hospital, London, UK
J I Harper
Affiliation:
Department of Dermatology, Great Ormond Street Hospital, London, UK
B E Hartley
Affiliation:
Department of ENT, Great Ormond Street Hospital, London, UK
*
Address for correspondence: Mr Yogesh Bajaj, 2 Tall Trees, Leeds LS17 7WA, UK Fax: +44 (0)113 266 3305 E-mail: ybajaj@hotmail.co.uk
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Abstract

Objective:

Treatment options for large subglottic haemangioma include steroids, laser ablation, open excision, tracheostomy and, more recently, propranolol. This article aims to present the Great Ormond Street Hospital guidelines for using propranolol to treat infantile isolated subglottic haemangioma by ENT surgeons.

Methods:

The vascular malformations multidisciplinary team at Great Ormond Street Hospital has developed guidelines for treating infantile haemangioma with propranolol.

Results:

The Great Ormond Street Hospital guidelines for propranolol treatment for infantile subglottic haemangioma include investigation, treatment and follow up. Propranolol is started at 1 mg/kg/day divided into three doses, increasing to 2 mg/kg/day one week later. On starting propranolol and when increasing the dose, the pulse rate and blood pressure must be checked every 30 minutes for the first 2 hours. Lesion response to treatment is assessed via serial endoscopy.

Conclusion:

Recent reports of dramatic responses to oral propranolol in children with haemangioma and acute airway obstruction have led to increased use. We advocate caution, and have developed guidelines (including pre-treatment investigation and monitoring) to improve treatment safety. Propranolol may in time prove to be the best medical treatment for subglottic haemangioma, but at present is considered to be still under evaluation.

Keywords

HemangiomaLarynxPropranololChild

Information

Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 127 , Issue 3 , March 2013 , pp. 295 - 298
Copyright
Copyright © JLO (1984) Limited 2013

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References

1Chang, LC, Haggstrom, AN, Drolet, BA. Growth characteristics of infantile hemangiomas: implications for management. Pediatrics 2008;122:360–7CrossRefGoogle ScholarPubMed
2Wiatrak, BJ, Reilly, JS, Seid, AB, Pransky, SM, Castillo, JV. Open surgical excision of subglottic hemangioma in children. Int J Pediatr Otorhinolaryngol 1996;34:191–206CrossRefGoogle ScholarPubMed
3McGill, TJ. Vascular anomalies of the head and neck. In: Wetmore, RF, Muntz, HR, McGill, TJ, eds. Pediatric Otolology: Principles and Practice Pathoways. New York: Thieme Medical Publishers, 2000;87–100Google Scholar
4Brodsky, L, Yoshpen, N, Ruben, RJ. Clinical-pathological correlates of congenital subglottic haemangiomas. Ann Otol Rhinol Laryngol Suppl 1983;205:4–18Google Scholar
5Sie, KCY, McGill, T, Healy, GB. Subglottic hemangioma: ten years' experience with the carbon dioxide laser. Ann Otol Rhinol Laryngol 1994;103:167–72CrossRefGoogle ScholarPubMed
6Bajaj, Y, Hartley, BEJ, Albert, DM, Bailey, CM. Subglottic haemangioma in children: experience with open surgical excision. J Laryngol Otol 2006;120:1033–7CrossRefGoogle ScholarPubMed
7Pierce, MK. Subglottic hemagiomas in infants – a presumptive clinical test for diagnosis. Ann Otol Rhinol Laryngol 1962;71:1057–62CrossRefGoogle Scholar
8George, ME, Sharma, V, Jacobson, J, Simon, S, Nopper, AJ. Adverse effects of systemic glucocorticoid therapy in infants with hemangiomas. Arch Dermatol 2004;140:963–9CrossRefGoogle ScholarPubMed
9Buckmiller, LM, Munson, PD, Dyamenahalli, U, Dai, Y, Richter, GT. Propranolol for infantile hemangiomas: early experience at a tertiary vascular anomalies center. Laryngoscope 2010;120:676–81CrossRefGoogle Scholar
10Messner, AH, Perkins, JA, Messner, AH, Chang, KW. Propranolol for the treatment of airway hemangiomas: a case series and treatment algorithm. Int J Pediatr Otorhinolaryngol 2010;74:1043–8Google Scholar
11Haggstrom, AN, Drolet, BA, Baselga, E. Prospective study of infantile hemangiomas: clinical characteristics predicting complications and treatment. Pediatrics 2006;118:882–7CrossRefGoogle ScholarPubMed
12Corbett, HJ, Mann, KS, Mitra, I, Jesudason, EC, Losty, PD, Clarke, PW. Tracheostomy – a 10-year experience from a UK pediatric surgical centre. J Pediatr Surg 2010;42:1251–4CrossRefGoogle Scholar
13Cotton, RT, Tewfik, TL. Laryngeal stenosis following carbon dioxide laser in subglottic hemangioma. Report of three cases. Ann Otol Rhinol Laryngol 1985;94:494–7CrossRefGoogle ScholarPubMed
14Leaute-Labreze, C, Dumas de la Roque, E, Hubiche, T, Boralevi, F, Thambo, JB, Taieb, A. Propranolol for severe hemangiomas of infancy. N Eng J Med 2008;358:2649–51CrossRefGoogle ScholarPubMed
15Buckmiller, L, Dyamenahalli, U, Richter, GT. Propranolol for airway hemangiomas: case report of novel treatment. Laryngoscope 2010;119:2051–4CrossRefGoogle Scholar
16Denoyelle, F, Leboulanger, N, Enjolras, O, Harris, R, Roger, G, Garabedian, EN. Role of propranolol in the therapeutic strategy of infantile laryngotracheal hemangiomas. Int J Pediatr Otorhinolaryngol 2009;73:1168–72CrossRefGoogle Scholar
17Maturo, S, Hartnick, C. Initial experience using propranolol as the sole treatment for infantile airway hemangioma. Int J Pediatr Otorhinolaryngol 2010;74:323–5CrossRefGoogle Scholar
18Leboulanger, N, Fayoux, P, Teissier, N, Cox, A, Van den Abeele, T, Carrabin, L et al. Propranolol in the therapeutic strategy of infantile laryngotracheal hemangioma: a preliminary retrospective study of French experience. Int J Pediatr Otorhinolaryngol 2010;74:1254–7CrossRefGoogle ScholarPubMed
19Goswamy, J, Rothera, MP, Bruce, IA. Failure of propranolol in the treatment of childhood haemangiomas of the head and neck. J Laryngol Otol 2011;125:1164–72CrossRefGoogle ScholarPubMed
20Siegfried, EC, Keenan, WJ, Al-Jureidini, S. More on propranolol for hemangiomas of infancy. N Eng J Med 2008;358:2846–7Google Scholar