Department of Otolaryngology - Head and Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Department of Dermatology, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Int J Pediatr Otorhinolaryngol. 2021 May;144:110688. doi: 10.1016/j.ijporl.2021.110688. Epub 2021 Mar 21.
The beta-blocker propranolol is the standard medical therapy for subglottic hemangioma (SGH), but side effects and incomplete response rates require close monitoring. Nadolol has been identified as a potential alternative but its use has not been examined for SGH.
Single institution retrospective cohort study of pediatric SGH treated with propranolol or nadolol.
Thirteen children (1 male, 12 female) with SGH were included: 6 were treated with propranolol (2.0-3.5 mg/kg/d) and 7 with nadolol (2.0-4.0 mg/kg/d). The most common presenting symptom was stridor (85%) and mean (SD) symptom duration prior to diagnosis was 4.6 (3.8) weeks. Cutaneous vascular lesions were present in 54%. There were 7 right-sided, 5 left-sided and 1 bilateral SGH. The mean (SD) percentage of airway obstruction was 60.6% (27.4). The response rate was 100% (6/6) for propranolol and 85.7% (6/7) for nadolol (p = 0.36). Mean (SD) time to symptomatic improvement was 2.6 (2.2) days with no difference across groups (p = 0.71). There was no hypotension, hypoglycemia, weight loss, or sleep disturbances in either group. One patient in the propranolol group experienced vomiting. Two patients in the nadolol group required dosage reduction due to asymptomatic bradycardia. The mean (SD) duration of admission was 14.4 (12.6) days and duration of treatment was 13.8 (11.2) days with no difference across groups (p = 0.23; p = 0.31, respectively). All patients had treatment initiated as inpatients and completed as outpatients.
Children with SGH treated with propranolol or nadolol had similar response rates and side effect profiles.
β受体阻滞剂普萘洛尔是治疗声门下血管瘤（SGH）的标准医学疗法，但副作用和不完全反应率需要密切监测。纳多洛尔已被确定为一种潜在的替代药物，但尚未对 SGH 进行过使用研究。
对接受普萘洛尔或纳多洛尔治疗的小儿 SGH 进行单机构回顾性队列研究。
纳入了 13 名患有 SGH 的儿童（1 名男性，12 名女性）：6 名接受普萘洛尔（2.0-3.5mg/kg/d）治疗，7 名接受纳多洛尔（2.0-4.0mg/kg/d）治疗。最常见的表现症状为喘鸣（85%），确诊前症状持续时间的平均值（标准差）为 4.6（3.8）周。54%存在皮肤血管病变。7 例为右侧，5 例为左侧，1 例为双侧 SGH。气道阻塞的平均（标准差）百分比为 60.6%（27.4）。普萘洛尔的反应率为 100%（6/6），纳多洛尔为 85.7%（6/7）（p=0.36）。症状改善的平均（标准差）时间为 2.6（2.2）天，两组之间无差异（p=0.71）。两组均无低血压、低血糖、体重减轻或睡眠障碍。普萘洛尔组中有 1 例出现呕吐。纳多洛尔组中有 2 例因无症状性心动过缓需要减少剂量。住院的平均（标准差）时间为 14.4（12.6）天，治疗的平均（标准差）时间为 13.8（11.2）天，两组之间无差异（p=0.23；p=0.31）。所有患者均以内科治疗开始，并以门诊治疗结束。
接受普萘洛尔或纳多洛尔治疗的 SGH 患儿的反应率和副作用谱相似。
