Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
Section of Dermatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Pediatr Dermatol. 2024 Jul-Aug;41(4):621-627. doi: 10.1111/pde.15623. Epub 2024 Apr 17.
Infantile hemangiomas are common vascular tumors in children. Propranolol has proven effective in treating infantile hemangiomas and while generally safe, has potential risk for more serious side effects of hypoglycemia, hypotension, bradycardia, bronchospasm, and cardiovascular or respiratory compromise. Current prescribing guidelines recommend initiating propranolol doses at 1 mg/kg/day, with up-titration to 2 mg/kg/day. This study aims to compare the incidence of adverse events in infants and children treated with propranolol initiated at 1 mg/kg/day versus being initiated directly at 2 mg/kg/day.
A retrospective cohort study was conducted using medical records of patients receiving propranolol therapy for infantile hemangiomas between October 2018-March 2021 at the Children's Hospital of Philadelphia. Patients were categorized by initial propranolol dosage: 1 or 2 mg/kg/day. The primary outcome measures included parent-reported adverse events, hypotension (defined by the Pediatric Advanced Life Support criteria), and bradycardia (defined as <1st percentile for age) following propranolol initiation.
Out of the 244 patients identified, 123 were initiated at the 1 mg/kg/day dose, and 121 at the 2 mg/kg/day dose. There was no significant difference in the incidence of adverse events between the two groups (p = .057). Additionally, among patients initiated at 2 mg/kg/day, there were no significant differences in the incidence of age-related or weight-related adverse events for those younger than 2 months or those in the 1st or 2nd quartile for weight (p = .53).
Infants and children initiated at 2 mg/kg/day did not demonstrate an increased incidence of adverse events associated with propranolol compared to those initiated at 1 mg/kg/day. These findings provide clinical evidence for the practice of accelerated propranolol initiation dosing.
婴幼儿血管瘤是儿童中常见的血管肿瘤。普萘洛尔已被证明对婴幼儿血管瘤有效，且通常安全，但存在低血糖、低血压、心动过缓、支气管痉挛以及心血管或呼吸系统功能障碍等更严重副作用的潜在风险。目前的处方指南建议以 1mg/kg/天的起始剂量开始使用普萘洛尔，并逐渐增加至 2mg/kg/天。本研究旨在比较以 1mg/kg/天起始与直接以 2mg/kg/天起始治疗婴幼儿血管瘤的婴儿和儿童中不良事件的发生率。
使用费城儿童医院 2018 年 10 月至 2021 年 3 月期间接受普萘洛尔治疗婴幼儿血管瘤的患者病历进行回顾性队列研究。患者按初始普萘洛尔剂量分为：1 或 2mg/kg/天。主要结局指标包括父母报告的不良事件、低血压（根据儿科高级生命支持标准定义）和普萘洛尔起始后的心动过缓（定义为年龄的第 1 百分位数以下）。
在确定的 244 例患者中，有 123 例以 1mg/kg/天的剂量起始，121 例以 2mg/kg/天的剂量起始。两组不良事件的发生率无显著差异（p=0.057）。此外，在以 2mg/kg/天起始的患者中，年龄小于 2 个月或体重处于第 1 或第 2 四分位的患者，年龄相关或体重相关不良事件的发生率无显著差异（p=0.53）。
与以 1mg/kg/天起始相比，以 2mg/kg/天起始的婴儿和儿童未显示出与普萘洛尔相关的不良事件发生率增加。这些发现为加速普萘洛尔起始剂量的临床实践提供了证据。
