Clinical and Laboratory ObservationPropranolol for the Treatment of a Life-Threatening Subglottic and Mediastinal Infantile Hemangioma
Section snippets
Patient Presentation
A 5-week-old female infant had a 1-week history of progressive stridor and respiratory distress. No evidence of cutaneous hemangiomas was found with a physical exmaination. With direct laryngoscopy and bronchoscopy, a left-sided SH that was treated with endoscopic CO2 laser ablation was revealed. She was discharged home receiving oral dexamethasone, but soon further stridor and feeding intolerance developed.
She was then referred to Lucile Packard Children's Hospital. A second CO2 laser ablation
Discussion
Although IHs are benign tumors, SHs are potentially life-threatening because of obstruction of the airway during the proliferative phase. In a 1961 review, Ferguson reported a 50% mortality rate in affected infants.6 At that time, treatment was limited to tracheostomy. Today, treatment options include systemic and intralesional corticosteroids, laser ablation, open submucosal resection, and tracheostomy, with a reduction in mortality rate to 4%.7 Cases of intra-thoracic and mediastinal
References (16)
- et al.
Prospective study of infantile hemangiomas: demographic, prenatal, and perinatal characteristics
J Pediatr
(2007) - et al.
Management of congenital subglottic hemangioma: trends and success over the past 17 years
Otolaryngol Head Neck Surg
(2005) - et al.
Role of propranolol in the therapeutic strategy of infantile laryngotracheal hemangioma
Int J Pediatr Otorhinolaryngol
(2009) - et al.
Current knowledge of the pathogenesis of infantile hemangiomas
Arch Facial Plast Surg
(2005) - et al.
Infantile hemangiomas: an emerging health issue linked to an increased rate of low birth weight infants
J Pediatr
(2008) - et al.
Growth characteristics of infantile hemangiomas: implications for management
Pediatrics
(2008) Problems related to systemic glucocorticoid therapy in children
J Rheumatol Suppl
(1993)- et al.
Subglottic hemangioma as a cause of respiratory obstruction in infants
Ann Otol Rhinol Laryngol
(1961)
Cited by (82)
Evaluation and Management of the Pediatric Airway
2021, Cummings Pediatric OtolaryngologyThe Pediatric Airway
2019, A Practice of Anesthesia for Infants and ChildrenMediastinal haemangioma and the role of GLUT1
2019, Anales de PediatriaManagement of Infantile Hemangiomas of the Airway
2018, Otolaryngologic Clinics of North AmericaThe Pediatric Airway
2018, A Practice of Anesthesia for Infants and ChildrenThe use of propranolol in the treatment of subglottic hemangiomas: A literature review and meta-analysis
2016, International Journal of Pediatric OtorhinolaryngologyCitation Excerpt :A subsequent randomized clinical trial showed that infants who received propranolol showed statistically significant reduction in the thickness of their hemangiomas as compared to a placebo group [13]. Propranolol has since become the first-line treatment for infantile hemangiomas, including those of the subglottis, producing excellent results in a number of case reports and retrospective series [4,5,14–30]. Side effects of propranolol are rare, but may include bradycardia, hypotension, and hypoglycemia [18].
The authors declare no conflicts of interest.