유아 혈관종에서 저용량 Propranolol의 사용 적절성 평가

Abstract

Infantile hemangiomas (IH) are the most common benign tumor during childhood. The majority are self-resolving, however, 10% of patients require treatment. Researches on theefficacy of propranolol for IH have been reported outside of Korea since 2008. This study evaluateda low-dose propranolol use on IH based on its clinical efficacy and adverse event profiles. Total of 59 children, 3-year-old or younger, diagnosed IH and took propranolol as a maintenancedosage of 2 mg/kg/day between November 2009 and July 2011, were culled from SeoulNational University Children’s Hospital using electrolyte medical records retrospectively. Forcomparison, clinical photos were taken before, during and after treatment. IH was predominantly presented in female (Male: Female=1:2.5), 39% of which occurred and wasdistinguished at birth (n=23). For the remains (n=36), 69% of children (n=25) occurred within amonth. Location of the IH was as follows: face and neck (n=44), trunk (n=4), the limbs (n=6), multiples (n=5), respectively. Mean age of treatment initiation was 5-month-old (range 1.3-16)and the total duration of treatment was an average of 8 months (range 2.3-22). 22% of patientsshowed a rebound growth when the medication was discontinued and restarted propranolol,receiving relatively shorter courses; a mean of 4 months (range 1 week - 11 months). Based on theinitial diagnosis, more than 50% of the reduction in the size of lesion was exhibited at 48patients, followed by four with less reduction and no changes in seven. Total 59% of patients(n=36) displayed improvement within a month such as a regression in size, softening in the lesionand faded in color. 22 patients experienced minor but reportable side effects to propranolol,including rash (n=8), gastro-esophageal reflux (n=7), hypotension (n=3), somnolence (n=2), andothers (respiratory distress, n=1, hypothermia, n=1), respectively. In this study, the clinical efficacy of low-dose propranolol use on IH was confirmed. Due to thelimited data from Seoul National University Children’s Hospital, prospective studies with morepatients are needed and the guideline for duration and dosage of propranolol should be furtherelaborated.