The Use of Propranolol in Infantile Subglottic Hemangiomas

Abstract

Objective: The discovery of propanolol for treatment of hemangiomas is a breakthrough, as current modalities are hampered by unpredictable outcomes and complications. Currently, there is a lack of long-term data. We aim to contribute with our series of 3 patients with subglottic hemangiomas causing airway compromise, treated successfully with propanolol.

Method: A detailed retrospective review of 3 patients who had received oral propanolol for the treatment of their subglottic hemangiomas was conducted based on the patients’ records. We documented their clinical history, degree of airway compromise, and duration of treatment and outcome with oral propanolol.

Results: Patient 1 was a 23-day-old girl who had a 1-week history of stridor complicated by spontaneous rib fractures. Patient 2 was a 3-month-old girl who had a 1-month history of stridor associated with a beard distribution of cutaneous hemangiomas. Patient 3 was a 2-month-old girl who had intermittent stridor from third week of birth. All children required intubation for relief of respiratory distress. Microlaryngobronchoscopy was performed for diagnosis and follow-up at regular intervals. Cardiac echography was done prior to oral propanolol commencement at 1mg/kg/d, which was gradually escalated to 2mg/kg/d. All patients demonstrated significant clinical improvement at one week.

Conclusion: While the patients demonstrated remarkable clinical improvement at one week, radiological response (magnetic resonance imaging) was muted in contrast. This remarkable clinical response was not found to be sustained at 6 months interval. Propanolol may have to be combined with another modality of treatment to achieve a long-term positive outcome.