G134 Oral propranolol in the management of infantile haemangiomas

Introduction We report our experience of treating infantile haemangiomas with oral propranolol. Two paediatricians with interest initiated and followed up the majority of the children. Methods A list of relevant children over a 6 year period (2012–2018)was generated by the treating clinicians. Data was collected from electronic record system. Our treatment protocol was 1 mg/kg/day in 3 divided doses during first week and 2 mg/kg/day in 3 divided doses from 2nd week. Children were admitted to the paediatric unit for intiaition of treatment (first dose) and for increasing the dose (on the second week) Results Out of the 73 patients referred, we had treated 43 children. There were 33 females and 10 males. The age at start of treatment varied from 2 weeks to 26 months with a median age of 3 months (12 children). We treated 30 (70%) solitary haemangiomas and 13 (30%) multiple haemangiomas. The majority of Solitary haemangiomas (19) were located in the head and neck regions. Indications for treatment in our cohort included bleeding, ulceration, infection, visual/nasal/auditory canal obstruction, feeding difficulties (lip), large size, risky location (e.g. nappy area, flexural surfaces) and parental request for facial haemangiomas. Two patients had MRI head and echo cardiogram but none of them had PHACES Syndrome. 35 had received 2 mg/kg/day, 4 had received a dose of 3 mg/kg/day and one up to 3.5 mg/kg/day without any problems. Treatment duration ranged between 6 months to 2 years. One child had low blood pressure but as other observations were normal the dose increase was deferred for 2 weeks. There were parental concerns about sleep disturbance in another child and so treatment was stopped at 6 months at which point the lesion had healed. Outcome 34 children had a good response and 7 had a partial response and 2 were lost to follow up. Conclusion Oral propranolol is very effective in treating IH complicated by ulceration/bleeding and proliferative IH. Using higher doses of 3 mg/kg/day is well tolerated and reduced duration of treatment. Propranolol use has been safe in our experience, therefore we are likely to modify our protocol to start treatment at 2 mg/kg/day for children above 3.5kgs as this would reduce the number of DU admissions.