Complications
While propranolol is considered relatively safe, adverse effects have been reported, including hypoglycemia, bronchospasm, hypotension, and hypothermia. For this reason, most academic medical centres have a protocol in place for the initiation of the medication. Because pediatric cardiologists are most familiar with the use of propranolol in infants, they often work collaboratively with the prescribing physician.
Protocols vary by institution but usually include a thorough medical history and physical examination, an electrocardiogram, an echocardiogram, and post-medication monitoring of heart rate, blood pressure, and glucose in an inpatient or outpatient setting.
About 41% of referred patients have facial involvement, and 43% of these infantile hemangiomas require treatment. The high level of subsequent treatment reflects the likelihood of hemangioma on the face to impinge on important adjacent structures (eyes, ears, nose, and mouth) as well as to cause potentially permanent soft tissue distortion. Treatment requires early referral to appropriate specialty care.
Adverse effects of prolonged, high-dose oral corticosteroids are common and include cushingoid facies, irritability, gastric upset, thrush or candidal diaper dermatitis, and diminished height and weight gain. Additional concerns include an increased risk of serious, even life-threatening, infections due to systemic immunosuppression. Other worrisome adverse effects include hypertension and hypothalamic-pituitary-adrenal axis suppression.
Intralesional injection of corticosteroids to periorbital infantile hemangioma has resulted in retinal and ophthalmic artery occlusion leading to vision loss.[74] Presumably, injection pressures may result in retrograde flow of particulate matter into these vessels. Treatment requires referral to appropriate specialty care.
About 5% to 10% of hemangiomas ulcerate. Overlying skin breaks down and fails to re-epithelialize. Bleeding, crusting, pain, and secondary infection may occur. Treatment goals are to heal the ulceration, prevent or treat secondary infection, and control pain. Systemic beta-blockers may be helpful to treat recalcitrant, ulcerated infantile hemangioma. The mechanism of action is not understood.[2][16]
Hemangioma may displace, distort, or compress functional adjacent structures, such as the airway. Signs of impending asphyxiation (gasping for air, clutching at the throat, collapse without apparent cause) should be met with urgent attempts to assure airway, breathing, and circulation, followed by appropriate specialist referral for relief of the obstruction.
High-output cardiac failure may ensue from an expansive visceral hemangioma with shunting into large-volume vascular spaces. Abdominal ultrasound is indicated in this context because the gastrointestinal tract is the primary site of these lesions. Treatment requires referral to appropriate specialty care.
Use of this content is subject to our disclaimer