Consensus statement for the treatment of infantile haemangiomas with propranolol

Although the majority of infantile haemangiomas do not require treatment due to the natural history of spontaneous involution, some do. The Australasian Vascular Anomalies Network and the Australasian Paediatric Dermatology Network have developed a consensus statement for the treatment of infantile haemangiomas with oral propranolol.
Infants with haemangiomas that are life-threatening, at risk of ulceration, or at risk of causing significant functional impairment, psychological impact or physical deformity should be treated early with oral propranolol. In most healthy infants, oral propranolol can be started in an outpatient setting. Thorough medical history and physical examination are important and necessary, but routine tests are not indicated unless history/examination dictates.
Start propranolol at a daily dose of 1-2 mg/kg, divided into two doses taken 8-12 hours apart. Increase to 2mg/kg/day after 1-2 weeks, unless a lower dose is clinically effective. In smaller infants, and infants with other clinical concerns, consider a lower initial dose, slower increases in dose, or administering the first dose as an inpatient.
Infants should be reviewed monthly until the haemangioma shows clear signs of involution, and then 3-monthly until treatment is stopped. The optimal treatment period has not been established and may vary from 3-24 months. Propranolol can be stopped safely without the need for weaning the dose.
Be aware of bradycardia, hypoglycaemia and bronchospasm. Special care needs to be exercised, or consider referral to an expert, in infants prone to hypoglycaemia, those with cardiovascular disease, or for infants with complex haemangiomas, particularly if they have intracranial components.

Dr. Sarah Smithson