CORRESPONDENCE Pediatric Dermatology Vol. 31 No. 2 264, 2014 Letters to the Editor are welcomed for publication (subject to editing). Letters must be signed by all authors, and must not exceed two pages of text including references. Letters should not duplicate material submitted or published in other journals. Prepublication proofs will not be provided.
OUTPATIENT TREATMENT OF HEMANGIOMAS WITH PROPRANOLOL To the Editor: Liu et al (1) report data on 31 children admitted to the hospital for 24 hours for commencement of oral propranolol treatment for infantile hemangiomas. Their article reinforces a growing consensus that such hospitalization is not necessary for most infants. Although they found statistically significant small decreases in heart rate and blood pressure after administration of propranolol, none of the differences were clinically significant (e.g., a decrease in heart rate of 5 beats/minute). Of particular interest, the lightest and shortest infants in their study did not show any greater effects than the larger and longer infants. We previously reported our experience treating 200 infants with hemangiomas with oral propranolol therapy commenced in an outpatient setting with no medical monitoring after the starting dose or after
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dose increases (2). Twenty-nine of our infants were younger than 2 months old (2). Our data support the conclusion of Liu et al that routine inpatient monitoring of a clinically normal, thriving infant is not necessary. As Liu et al state, an inpatient stay has many disadvantages, including nosocomial infections. Our policy has been to give families written instructions to stop propranolol should their children become unwell or wheezy or not feed normally for any reason. We continue to monitor all infants over the long term because of the possibility of currently unrecognized longer-term side effects in this age group. REFERENCES 1. Liu LS, Sokoloff D, Antaya RJ. Twenty-four-hour hospitalization for patients initiating systemic propranolol therapy for infantile hemangiomas—is it indicated? Pediatr Dermatol 2013;30:554–560. 2. Phillips RJ, Penington AJ, Bekhor PS et al. Use of propranolol for treatment of infantile haemangiomas in an outpatient setting. J Paediatr Child Health 2012; 48:902–906. ROD PHILLIPS, M.B.B.S., F.R.A.C.P., Ph.D. Melbourne, Victoria, Australia e-mail: [email protected]
© 2014 Wiley Periodicals, Inc.
OUTPATIENT TREATMENT OF HEMANGIOMAS WITH PROPRANOLOL To the Editor: Liu et al (1) report data on 31 children admitted to the hospital for 24 hours for commencement of oral propranolol treatment for infantile hemangiomas. Their article reinforces a growing consensus that such hospitalization is not necessary for most infants. Although they found statistically significant small decreases in heart rate and blood pressure after administration of propranolol, none of the differences were clinically significant (e.g., a decrease in heart rate of 5 beats/minute). Of particular interest, the lightest and shortest infants in their study did not show any greater effects than the larger and longer infants. We previously reported our experience treating 200 infants with hemangiomas with oral propranolol therapy commenced in an outpatient setting with no medical monitoring after the starting dose or after
264
dose increases (2). Twenty-nine of our infants were younger than 2 months old (2). Our data support the conclusion of Liu et al that routine inpatient monitoring of a clinically normal, thriving infant is not necessary. As Liu et al state, an inpatient stay has many disadvantages, including nosocomial infections. Our policy has been to give families written instructions to stop propranolol should their children become unwell or wheezy or not feed normally for any reason. We continue to monitor all infants over the long term because of the possibility of currently unrecognized longer-term side effects in this age group. REFERENCES 1. Liu LS, Sokoloff D, Antaya RJ. Twenty-four-hour hospitalization for patients initiating systemic propranolol therapy for infantile hemangiomas—is it indicated? Pediatr Dermatol 2013;30:554–560. 2. Phillips RJ, Penington AJ, Bekhor PS et al. Use of propranolol for treatment of infantile haemangiomas in an outpatient setting. J Paediatr Child Health 2012; 48:902–906. ROD PHILLIPS, M.B.B.S., F.R.A.C.P., Ph.D. Melbourne, Victoria, Australia e-mail: [email protected]
© 2014 Wiley Periodicals, Inc.
