Öz
Amaç: Çalışmamızın amacı, infantile hemanjiom tanılı hastaların propronalol tedavisi öncesi kardiyak bulgularını değerlendirmek, bulgularımızı literatür verileriyle karşılaştırarak ayrıntılı kardiyak taramanın gerekliliğini tartışmaktır.
Gereç ve Yöntem: Ekim 2021- Ekim 2022 tarihleri arasında, tek merkezde infantil hemanjiom tanısıyla propranolol tedavisi başlanan hastalar retrospektif olarak değerlendirildi. Tedavi öncesinde yapılan elektrokardiyografi ve ekokardiyografi sonuçlarının yanı sıra hastaların propranolol doz şeması, tedavi sırasında görülen semptomları, kalp hızı ve kan basıncını içeren fizik muayene bulguları geriye dönük olarak incelendi.
Bulgular: Toplam 50 hastanın 30'u kadındı. Hastaların yaş ortalamaları 7,1±7,3 ay, kilo ortalamaları ise 7,6±3,0 kg idi. Elektrokardiyografik (EKG) değerlendirmede tedavi başlanmasına engel bir durum saptanmadı. Propranolol tedavisinin, kalp hızı ve sistolik kan basıncını istatistiksel anlamlı ölçüde azalttığı izlendi (başlangıç: 120,2±10,5 dk/89,6±17,6 mmHg; 1. hafta: 118,5±10,4 dk/88,7±17,5 mmHg; 2. hafta: 117,8±9,5 dk/88,7±17,3 mmHg; 2. ay: 116,5±9,4 dk/88,6±17,3 mmHg). Diyastolik kan basıncının ise ‘başlangıç-1. hafta’ ile ‘başlangıç- 2. ay’ karşılaştırmasında anlamlı olarak azaldığı izlendi (sırasıyla 58,9±15,6 ve 58,2±15,8 mmHg; 58,9±15,6 ve 57,9±15,5 mmHg).
Sonuç: Propranolol tedavisi öncesi EKG ve hastane yatışının her hastada gerekli olmadığı yönündedir. Düşük yan etki profili göz önüne alındığında kılavuzların önerisi doğrultusunda hasta bazlı, öykü ve fizik muayenenin ön planda tutulduğu değerlendirme önerilmekte; elektrokardiyografi ve kan basıncı takibinin gerekliliği riskli hasta grubu için akılda tutulmalıdır.
Anahtar Kelimeler
Kaynakça
- Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, Horii KA et al. Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics. J Pediatr. 2007;150:291–4.
- Küpeli S. Evolving strategy in treatment of infantile hemangiomas: from steroids to propranolol. Cukurova Medical Journal. 2016;41:354-59.
- Maguiness SM, Frieden IJ. Current management of infantile hemangiomas. Semin Cutan Med Surg. 2010;29:106–114.
- Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, Horii KA et al. Prospective study of infantile hemangiomas: clinical characteristics predicting complications and treatment. Pediatrics. 2006;118:882-7.
- Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taïeb A. Propranolol for severe hemangiomas of infancy. N Engl J Med. 2008;358:2649-51.
- Holmes WJ, Mishra A, Gorst C, Liew SH. Propranolol as first-line treatment for rapidly proliferating infantile haemangiomas. J Plast Reconstr Aesthetic Surg. 2011;64:445–51.
- Fuchsmann C, Quintal MC, Giguere C, Ayari-Khalfallah S, Guibaud L, Powell J et al. Propranolol as first-line treatment of head and neck hemangiomas. Arch Otolaryngol Head Neck Surg. 2011;137:471–8.
- Schupp CJ, Kleber JB, Günther P, Holland-Cunz S. Propranolol therapy in 55 infants with infantile hemangioma: dosage, duration, adverse effects, and outcome. Pediatr Dermatol. 2011;28:640–4.
- Ji Y, Chen S, Xu C, Li L, Xiang B. The use of propranolol in the treatment of infantile hemangiomas: an update on potential mechanisms of action. Br J Dermatol. 2015;172:24-32.
- Raphael MF, Breugem CC, Vlasveld FA, de Graaf M, Slieker MG, Pasmans SG et al. Is cardiovascular evaluation necessary prior to and during beta-blocker therapy for infantile hemangiomas ?: A cohort study. J Am Acad Dermatol. 2015;72:465–72.
- Drolet BA, Frommelt PC, Chamlin SL, Haggstrom A, Bauman NM, Chiu YE et al. Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics. 2013;131:128–140.
- Johansen ML, Mahendran G, Lawley LP. Is prolonged monitoring necessary? an updated approach to infantile hemangioma treatment with oral propranolol. Pediatric Dermatology. 2021;00:1–6.
- Dinehart SM, Kincannon J, Geronemus R. Hemangiomas: evaluation and treatment. Dermatol Surg. 2001;27:475-85.
- Yarbrough KB, Tollefson MM, Krol AL, Leitenberger SL, Mann JA, MacArthur CJ. Is routine electrocardiography necessary before initiation of propranolol for treatment of infantile hemangiomas? Pediatr Dermatol. 2016;33:615-20.
- Streicher JL, Riley EB, Castelo-Soccio LA. Reevaluating the need for electrocardiograms prior to initiation of treatment with propranolol for infantile hemangiomas. JAMA Pediatr. 2016;170:906-7.
- Blei F, McElhinney DB, Guarini A, Presti S. Cardiac screening in infants with infantile hemangiomas before propranolol treatment. Pediatr Dermatol. 2014;31:465–70.
- Dyme JL, Thampan A, Han EJ, Nyirenda TL, Kotb ME, Shin HT. Propranolol for infantile haemangiomas: initiating treatment on an outpatient basis. Cardiol Young. 2012;22:424–9.
- Techasatian L, Komwilaisak P, Panombualert S, Uppala R, Jetsrisuparb C. Propranolol was effective in treating cutaneous infantile haemangiomas in thai children. Acta Paediatr. 2016;105:e257–62.
- Cushing SL, Boucek RJ, Manning SC, Sidbury R, Perkins JA. Initial experience with a multidisciplinary strategy for initiation of propranolol therapy for infantile hemangiomas. Otolaryngol Head Neck Surg. 2011;144:78–84.
- McSwiney E, Murray D, Murphy M. Propranolol therapy for cutaneous infantile haemangiomas initiated safely as a day-case procedure. Eur J Pediatr. 2014;173:63–8.
- Patel NJ, Bauman NM. How should propranolol be initiated for infantile hemangiomas: inpatient versus outpatient? Laryngoscope. 2014;124:1279–81.
- Phillips RJ, Penington AJ, Bekhor PS, Crock CM. Use of propranolol for treatment of infantile haemangiomas in an outpatient setting. J Paediatr Child Health. 2012;48:902–6.
- Püttgen KB, Hansen LM, Lauren C, Stefanko N, Mathes E, Olsen GM et al. Limited utility of repeated vital sign monitoring during initiation of oral propranolol for complicated infantile hemangioma. J Am Acad Dermatol. 2021;85:345-52.
- Pierre Fabre Pharmaceuticals I. Hemangeol™ product information Published 2014. Accessed. 2020.
- Biesbroeck L, Brandling-Bennett HA. Propranolol for infantile haemangiomas: review of report of a consensus conference. Arch Dis Child Educ Pract Ed. 2014;99:95-7.
- Kumar MG, Coughlin C, Bayliss SJ. Outpatient use of oral propranolol and topical timolol for infantile hemangiomas: survey results and comparison with propranolol consensus statement guidelines. Pediatr Dermatol. 2015;32:171-79.
- Bar J, Bar-Ilan E, Cleper R, Sprecher E, Samuelov L, Mashiah J. Monitoring oral propranolol for infantile hemangiomata. Dermatol Ther. 2022;35:e15870.
- Xu DP, Cao RY, Xue L, Sun NN, Tong S, Wang XK. Treatment of severe infantile hemangiomas with propranolol: an evaluation of the efficacy and effects of cardiovascular parameters in 25 consecutive patients. J Oral Maxillofac Surg. 2015;73:430-36.
- Kumar MG, Coughlin C, Bayliss SJ. Outpatient use of oral propranolol and topical timolol for infantile hemangiomas: survey results and comparison with propranolol consensus statement guidelines. Pediatr Dermatol. 2015;32:171-79.
- Léauté-Labrèze C, Hoeger P, Mazereeuw-Hautier J, Guibaud L, Baselga E, Posiunas G et al. A randomized, controlled trial of oral propranolol in infantile hemangioma. N Engl J Med. 2015;372:735-46.
- Abu-Rmaileh M, Hairston HC, Zaniletti I, Kompelli A, Davis KP, Gardner JR et al. Infantile hemangioma treated with propranolol readmission trends, complications of therapy, and cost: a PHIS database study. Int J Pediatr. 2022;2022:4423558
Öz
Purpose: The aim of this study is to evaluate the cardiac findings of patients with Infantile hemangiomas (IH) prior to propronalol treatment and to compare our findings with literature data and verify the need for detailed cardiac screening.
Materials and Methods: We performed a single-center retrospective review of patients diagnosed with IH who underwent cardiac screening between October 2021 and October 2022. Charts were reviewed and symptoms, heart rate, blood pressure, electrocardiogram, and echocardiogram findings were recorded for each patient.
Results: Of the 50 patients, 30 were female. The mean age and weight were 7.1±7.3 months and 7.6±3.0 kg. Electrocardiography screening did not reveal any contraindication for treatment. Propranolol significantly reduced heart rate and systolic blood pressure (baseline: 120.2±10.5 bpm/89.6±17.6 mmHg; 1st week: 118.5±10.4 bpm/88.7±17.5 mmHg; 2nd week: 117.8±9.5 bpm/88.7±17.3 mmHg; 2nd month: 116.5±9.4 bpm/88.6±17.3 mmHg). Diastolic pressure reduction was significant only between ‘baseline- 1st week and ‘baseline- 2nd month (58.9±15.6 vs 58.2±15.8 mmHg; 58.9±15.6 vs 57.9±15.5 mmHg, respectively).
Conclusion: Screening electrocardiography and hospitalization for initiation of propranolol therapy is not necessary in most infants. Given the low frequency of complications, it seems medical history and physical examination are the cornerstones for safe initiation and monitoring of β-blocker treatment. Electrocardiography and BP control should be part of the pretreatment evaluation in high-risk patients.
Anahtar Kelimeler
Kaynakça
- Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, Horii KA et al. Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics. J Pediatr. 2007;150:291–4.
- Küpeli S. Evolving strategy in treatment of infantile hemangiomas: from steroids to propranolol. Cukurova Medical Journal. 2016;41:354-59.
- Maguiness SM, Frieden IJ. Current management of infantile hemangiomas. Semin Cutan Med Surg. 2010;29:106–114.
- Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, Horii KA et al. Prospective study of infantile hemangiomas: clinical characteristics predicting complications and treatment. Pediatrics. 2006;118:882-7.
- Léauté-Labrèze C, Dumas de la Roque E, Hubiche T, Boralevi F, Thambo JB, Taïeb A. Propranolol for severe hemangiomas of infancy. N Engl J Med. 2008;358:2649-51.
- Holmes WJ, Mishra A, Gorst C, Liew SH. Propranolol as first-line treatment for rapidly proliferating infantile haemangiomas. J Plast Reconstr Aesthetic Surg. 2011;64:445–51.
- Fuchsmann C, Quintal MC, Giguere C, Ayari-Khalfallah S, Guibaud L, Powell J et al. Propranolol as first-line treatment of head and neck hemangiomas. Arch Otolaryngol Head Neck Surg. 2011;137:471–8.
- Schupp CJ, Kleber JB, Günther P, Holland-Cunz S. Propranolol therapy in 55 infants with infantile hemangioma: dosage, duration, adverse effects, and outcome. Pediatr Dermatol. 2011;28:640–4.
- Ji Y, Chen S, Xu C, Li L, Xiang B. The use of propranolol in the treatment of infantile hemangiomas: an update on potential mechanisms of action. Br J Dermatol. 2015;172:24-32.
- Raphael MF, Breugem CC, Vlasveld FA, de Graaf M, Slieker MG, Pasmans SG et al. Is cardiovascular evaluation necessary prior to and during beta-blocker therapy for infantile hemangiomas ?: A cohort study. J Am Acad Dermatol. 2015;72:465–72.
- Drolet BA, Frommelt PC, Chamlin SL, Haggstrom A, Bauman NM, Chiu YE et al. Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics. 2013;131:128–140.
- Johansen ML, Mahendran G, Lawley LP. Is prolonged monitoring necessary? an updated approach to infantile hemangioma treatment with oral propranolol. Pediatric Dermatology. 2021;00:1–6.
- Dinehart SM, Kincannon J, Geronemus R. Hemangiomas: evaluation and treatment. Dermatol Surg. 2001;27:475-85.
- Yarbrough KB, Tollefson MM, Krol AL, Leitenberger SL, Mann JA, MacArthur CJ. Is routine electrocardiography necessary before initiation of propranolol for treatment of infantile hemangiomas? Pediatr Dermatol. 2016;33:615-20.
- Streicher JL, Riley EB, Castelo-Soccio LA. Reevaluating the need for electrocardiograms prior to initiation of treatment with propranolol for infantile hemangiomas. JAMA Pediatr. 2016;170:906-7.
- Blei F, McElhinney DB, Guarini A, Presti S. Cardiac screening in infants with infantile hemangiomas before propranolol treatment. Pediatr Dermatol. 2014;31:465–70.
- Dyme JL, Thampan A, Han EJ, Nyirenda TL, Kotb ME, Shin HT. Propranolol for infantile haemangiomas: initiating treatment on an outpatient basis. Cardiol Young. 2012;22:424–9.
- Techasatian L, Komwilaisak P, Panombualert S, Uppala R, Jetsrisuparb C. Propranolol was effective in treating cutaneous infantile haemangiomas in thai children. Acta Paediatr. 2016;105:e257–62.
- Cushing SL, Boucek RJ, Manning SC, Sidbury R, Perkins JA. Initial experience with a multidisciplinary strategy for initiation of propranolol therapy for infantile hemangiomas. Otolaryngol Head Neck Surg. 2011;144:78–84.
- McSwiney E, Murray D, Murphy M. Propranolol therapy for cutaneous infantile haemangiomas initiated safely as a day-case procedure. Eur J Pediatr. 2014;173:63–8.
- Patel NJ, Bauman NM. How should propranolol be initiated for infantile hemangiomas: inpatient versus outpatient? Laryngoscope. 2014;124:1279–81.
- Phillips RJ, Penington AJ, Bekhor PS, Crock CM. Use of propranolol for treatment of infantile haemangiomas in an outpatient setting. J Paediatr Child Health. 2012;48:902–6.
- Püttgen KB, Hansen LM, Lauren C, Stefanko N, Mathes E, Olsen GM et al. Limited utility of repeated vital sign monitoring during initiation of oral propranolol for complicated infantile hemangioma. J Am Acad Dermatol. 2021;85:345-52.
- Pierre Fabre Pharmaceuticals I. Hemangeol™ product information Published 2014. Accessed. 2020.
- Biesbroeck L, Brandling-Bennett HA. Propranolol for infantile haemangiomas: review of report of a consensus conference. Arch Dis Child Educ Pract Ed. 2014;99:95-7.
- Kumar MG, Coughlin C, Bayliss SJ. Outpatient use of oral propranolol and topical timolol for infantile hemangiomas: survey results and comparison with propranolol consensus statement guidelines. Pediatr Dermatol. 2015;32:171-79.
- Bar J, Bar-Ilan E, Cleper R, Sprecher E, Samuelov L, Mashiah J. Monitoring oral propranolol for infantile hemangiomata. Dermatol Ther. 2022;35:e15870.
- Xu DP, Cao RY, Xue L, Sun NN, Tong S, Wang XK. Treatment of severe infantile hemangiomas with propranolol: an evaluation of the efficacy and effects of cardiovascular parameters in 25 consecutive patients. J Oral Maxillofac Surg. 2015;73:430-36.
- Kumar MG, Coughlin C, Bayliss SJ. Outpatient use of oral propranolol and topical timolol for infantile hemangiomas: survey results and comparison with propranolol consensus statement guidelines. Pediatr Dermatol. 2015;32:171-79.
- Léauté-Labrèze C, Hoeger P, Mazereeuw-Hautier J, Guibaud L, Baselga E, Posiunas G et al. A randomized, controlled trial of oral propranolol in infantile hemangioma. N Engl J Med. 2015;372:735-46.
- Abu-Rmaileh M, Hairston HC, Zaniletti I, Kompelli A, Davis KP, Gardner JR et al. Infantile hemangioma treated with propranolol readmission trends, complications of therapy, and cost: a PHIS database study. Int J Pediatr. 2022;2022:4423558
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Çocuk Kardiyolojisi |
| Bölüm | Araştırma |
| Yazarlar | |
| Erken Görünüm Tarihi | 26 Eylül 2023 |
| Yayımlanma Tarihi | 30 Eylül 2023 |
| Kabul Tarihi | 13 Eylül 2023 |
| Yayımlandığı Sayı | Yıl 2023 Cilt: 48 Sayı: 3 |
