Prolonged monitoring after propranolol use for infantile haemangioma does not predict adverse events

Repeated vital sign monitoring for initiation and escalation of oral propranolol has seldomly led to a change in management of infantile haemangioma and is not predictive of future adverse events, results of a recent study have shown. Serious adverse events occurring during therapy are few, of which none are cardiovascular.

This retrospective multicentre study was conducted to assess the utility of prolonged monitoring following first propranolol dose and escalation. Patients with a diagnosis of haemangioma requiring propranolol ≥0.3 mg/kg per dose, younger than 2 years of age, and with heart rate monitoring for ≥1 hour were included. Data on demographics, dose, vital signs, and adverse events were obtained.

Overall, 783 infants (median age at initiation 112 days) met the eligibility criteria. Of the 1,148 episodes of prolonged monitoring, none required immediate intervention or drug discontinuation. Neither symptomatic bradycardia nor hypotension occurred during monitoring.

Mean heart rate change was –8.19±15.54/min from baseline to 1 hour and –9.24±15.84/min from baseline to 2 hours.

Of note, dose adjustments were performed in three preterm infants due to prescriber concerns about asymptomatic vital sign changes. No significant differences were observed in pretreatment heart rate or in heart rate change between patients with later adverse events during treatment and those without.

“Initial propranolol recommendations for infantile hemangioma published in 2013 were intended as provisional best practices to be updated as evidence-based data emerged,” the authors said.