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Gomes R, Salazar L, Fraga C, Correia MR, Barbosa-Sequeira J, Fernandes A, Álvares S, Banquart Leitão J, Paiva Coelho M. Management of infantile hemangiomas-experience of a tertiary hospital. Eur J Pediatr 2023; 182:1611-1618. [PMID: 36705724 DOI: 10.1007/s00431-023-04827-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/07/2023] [Accepted: 01/15/2023] [Indexed: 01/28/2023]
Abstract
The purpose of the study is to describe the experience of a multidisciplinary team in a tertiary hospital regarding the management of Infantile Hemangiomas (IH). The method employed is a retrospective analysis of patients with IH followed in a tertiary pediatric hospital between January 2010 and May 2022. A total of 393 IH were diagnosed (56.7% female), with a median age of 5 months (interquartile range (IQR), 3-10). Imaging investigation was necessary for diagnosis and for exclusion of other IH in 9.2% and 14.3%, respectively. Focal (74.0%) and superficial (59.7%) lesions were more frequent as was facial location (35.9%). Pre-treatment ulceration or hemorrhage occurred in 6.6%. At follow-up, 87.4% regressed partially and 12.6% completely; 2.7% relapsed. Propranolol was started in 30.0% of cases for a median period of 9 months (IQR, 6-12), mainly due to esthetic concerns (41.9%). Side effects occurred in 8.3% (sleep disturbance in 5.1%). Only 1.7% were refractory and 5.9% had a rebound effect. Eleven patients were treated with topical timolol and 41 underwent surgery. Patients that were treated with propranolol had more risk factors (p = 0.016) and presented deeper lesions (p < 0.001) with a larger diameter (p < 0.001); total IH regression was less frequent (p < 0.001). Since 2020, twice-daily dosage was more frequently prescribed than three times daily (p = 0.007) and inpatient initiation of propranolol decreased (p = 0.750), without significant difference in the incidence of adverse reactions, duration of treatment, and lesion evolution. Conclusions: Our protocol proved to be safe and feasible in an outpatient setting and twice daily administration of propranolol was effective. The majority of IH showed at least partial regression. Early detection of high-risk IH is paramount and a multidisciplinary assessment by a specialized team is essential for adequate management. What is Known: • IH are the most common vascular tumors in childhood. Although the majority evolves favorably, treatment may be warranted in selected cases. • Early detection of high-risk IH is paramount, and a multidisciplinary assessment by a specialized team is essential for adequate management. What is New: • One-third of our sample was treated with propranolol. These patients had more risk factors and presented deeper lesions with a larger diameter, and tumor total regression was less frequent. • Our results reinforce safety and feasibility of propranolol initiation in an outpatient setting, including twice daily dosage.
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Affiliation(s)
- Rita Gomes
- Pediatrics Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Porto, Portugal.
| | - Luís Salazar
- Pediatrics Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Porto, Portugal
| | - Carolina Fraga
- Pediatrics Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Porto, Portugal
| | - Mário Rui Correia
- Pediatric Surgery Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Porto, Portugal
| | | | - Alexandre Fernandes
- Pediatrics Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Porto, Portugal
| | - Sílvia Álvares
- Pediatric Cardiology Department, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Unit for Multidisciplinary Research in Biomedicine (UMIB), School of Medicine and Biomedical Sciences (ICBAS), Centro Materno Infantil Do Norte Albino Aroso, Porto, Portugal
| | - José Banquart Leitão
- Pediatric Surgery Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Porto, Portugal
| | - Margarida Paiva Coelho
- Pediatrics Department, Centro Materno Infantil Do Norte Albino Aroso, Centro Hospitalar Universitário Do Porto (CMIN-CHUPorto), Porto, Portugal
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2
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Xu W, Zhao H. Management of infantile hemangiomas: Recent advances. Front Oncol 2022; 12:1064048. [PMID: 36523969 PMCID: PMC9745076 DOI: 10.3389/fonc.2022.1064048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/10/2022] [Indexed: 11/30/2022] Open
Abstract
Infantile hemangiomas (IHs) are benign vascular tumors commonly observed in children. A small number of cases can manifest as organ or system dysfunction, permanent scarring, or even disfigurement. Currently, diagnosis is mainly based on clinical history, physical examination, and auxiliary inspection. In the treatment of a hemangioma, the functional damage caused by the lesion and complications that may endanger the patient’s life should be given priority. This suggests that identification, diagnosis, and referral to specialists during the early stages of IHs are important factors in preventing related complications and obtaining a better prognosis. During the past few decades, researchers have explored different treatments according to the condition, including oral or topical drugs, topical drug injections, laser surgery, and surgical treatment. However, oral propranolol remains a well-accepted first-line treatment. This article will primarily focus on the recent advances in the clinical diagnosis and treatment of hemangiomas, along with a literature review on the subject.
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3
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Mayer JLR, Intzes S, Oza VS, Blei F. How we approach hemangiomas in infants. Pediatr Blood Cancer 2022; 69 Suppl 3:e29077. [PMID: 34151510 DOI: 10.1002/pbc.29077] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/09/2021] [Indexed: 12/28/2022]
Abstract
Pediatric oncologists are increasingly involved in the management of benign vascular tumors and their associated life-threatening complications. Hemangiomas are the most common referring diagnosis to multidisciplinary vascular anomalies clinics. However, as contemporary research has revealed, hemangiomas are not a single, easily defined entity but rather a diverse set of related vascular tumors, each having a unique natural history, growth pattern, and response to therapy. This manuscript seeks to illustrate how we evaluate and manage these complex tumors, their complications, and associated syndromes, while remaining ever vigilant for malignant hemangioma mimickers such as soft tissue sarcomas and congenital leukemia.
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Affiliation(s)
- Jennifer L R Mayer
- Vascular Anomalies and Birthmarks Program, Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Stefanos Intzes
- Pediatric Hematology/Oncology, Providence Sacred Heart Children's Hospital, Spokane, Washington, USA
| | - Vikash S Oza
- Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York, New York, USA
| | - Francine Blei
- Hemangioma and Vascular/Lymphatic Malformations Program, New York University Langone Health, New York, New York, USA
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4
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Lv Z, Yang K, Wang Y. Long non-coding RNA breast cancer-associated transcript 54 sponges microRNA-1269b to suppress the proliferation of hemangioma-derived endothelial cells. Bioengineered 2022; 13:6188-6195. [PMID: 35200096 PMCID: PMC8974170 DOI: 10.1080/21655979.2022.2027064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Long non-coding RNA (lncRNA) breast cancer-associated transcript 54 (BRCAT54) and microRNA-1269b (miR-1269b) are two critical ncRNAs in cancer biology, while their roles in hemangioma are unknown. Our preliminary sequencing data revealed their altered expression in hemangioma and predicted they could interact with each other. This study was therefore carried out to investigate the roles of BRCAT54 and miR-1269b in hemangioma, with a focus on their interaction. In this study, hemangioma samples donated by 20 infantile hemangioma patients at proliferating-phase and 20 infantile hemangioma patients at involuting-phase were used. The expression of BRCAT54 and miR-1269b in hemangioma samples, as well as hemangioma-derived endothelial cells (HDECs) and human umbilical vein endothelial cells (HUVECs) were detected by RT-qPCR. IntaRNA 2.0 was applied to predict the interaction between BRCAT54 and miR-1269b, which was then confirmed by RNA-RNA pulldown assay. Accumulation of BRCAT54 in the subcellular location of HDECs was detected by subcellular fractionation assay. The role of BRCAT54 and miR-1269b in cell proliferation has been explored by the BrdU assay. Compared to proliferating-phase tissues, involuting-phase tissues exhibited decreased expression levels of BRCAT54 and increased expression levels of miR-1269b. HDECs had decreased expression levels of BRCAT54 and increased expression levels of miR-1269b compared to that of HUVECs. In HDECs, BRCAT54, which was detected in both nuclear and cytoplasm fractions, directly interacted with miR-1269b. BRCAT54 and miR-1269b did not affect the expression of each other, while BRCAT54 suppressed the role of miR-1269b in enhancing the proliferation of HDECs. BRCAT54 may sponge miR-1269b to suppress the proliferation of HDECs.
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Affiliation(s)
- Zhonjun Lv
- Department of Vascular Surgery, Nanyang Central Hospital, Nanyang, Henan Province, China
| | - Ke Yang
- Department of Vascular Surgery, Nanyang Central Hospital, Nanyang, Henan Province, China
| | - Ya Wang
- Department of Vascular Surgery, Nanyang Central Hospital, Nanyang, Henan Province, China
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5
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Marcoux S, Théorêt Y, Dubois J, Essouri S, Pincivy A, Coulombe J, McCuaig C, Powell J, Soulez G, Kleiber N. Systemic, local, and sclerotherapy drugs: What do we know about drug prescribing in vascular anomalies? Pediatr Blood Cancer 2021; 68:e29364. [PMID: 34596969 DOI: 10.1002/pbc.29364] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/08/2021] [Accepted: 08/31/2021] [Indexed: 01/20/2023]
Abstract
Off-label drug prescribing, frequent in the treatment of vascular anomalies (VA), relies on the quality of the literature reporting drug efficacy and safety. Our objective is to review the level of evidence (LOE) surrounding drug use in VA, which is more prevalent in pediatric care. A list of drugs used in VA was created with a literature review in July 2020. For each drug listed, the article displaying the highest LOE was determined and then compared between efficacy/safety data, routes of administration, pharmacological categories and a subset of VA. The influence of research quality on study results was also explored. The median LOE for the 74 drugs identified poor methodological quality, with a predominance of retrospective studies or case reports. Drug safety is currently inadequately reported. This is alarming as many treatments display significant safety concerns. Also, current literature displays major publication bias that probably leads to overestimation of drug efficacy in VA.
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Affiliation(s)
- Simon Marcoux
- Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada.,Clinical Pharmacology Unit, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Yves Théorêt
- Department of Pharmacology and Physiology, Université de Montréal, Montréal, Quebec, Canada.,Clinical Pharmacology Unit, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Josée Dubois
- Department of Radiology, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Sandrine Essouri
- Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Research Center, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Alix Pincivy
- Library, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Jérôme Coulombe
- Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Division of Dermatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Catherine McCuaig
- Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Division of Dermatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Julie Powell
- Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Division of Dermatology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
| | - Gilles Soulez
- Department of Radiology, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Quebec, Canada
| | - Niina Kleiber
- Department of Pharmacology and Physiology, Université de Montréal, Montréal, Quebec, Canada.,Clinical Pharmacology Unit, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Vascular Anomaly Team, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.,Research Center, CHU Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada
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6
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Tan X, Guo S, Wang C. Propranolol in the Treatment of Infantile Hemangiomas. Clin Cosmet Investig Dermatol 2021; 14:1155-1163. [PMID: 34511960 PMCID: PMC8423716 DOI: 10.2147/ccid.s332625] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/24/2021] [Indexed: 12/31/2022]
Abstract
Propranolol, as the first generation of β-blocker family, was initially introduced in the clinical application for tachycardia and hypertension in the 1960s. However, the occasional discovery of propranolol in the involution of infantile hemangiomas (IHs) brought us a new perspective. IHs are the most common infantile tumor, affecting 4–10% newborns. So far, oral propranolol is the first-line medication for IHs treatment. At the same time, local injection and topical propranolol are developing. Despite the worldwide application, the precise mechanism of propranolol of IHs has not been completely studied. In this article, we reviewed and summarized the current information on pharmacology, mechanism, efficacy, and adverse effects of propranolol. Novel design of biomaterials and bioactive molecules are needed for new treatment and ideal pathway to attain the minimal effective treatment concentration and eliminate the adverse effects.
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Affiliation(s)
- Xin Tan
- Department of Plastic Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Shu Guo
- Department of Plastic Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
| | - Chenchao Wang
- Department of Plastic Surgery, First Hospital of China Medical University, Shenyang, Liaoning Province, People's Republic of China
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7
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Luca AC, Miron IC, Trandafir LM, Cojocaru E, Pădureţ IA, Trandafirescu MF, Iordache AC, Ţarcă E. Morphological, genetic and clinical correlations in infantile hemangiomas and their mimics. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:687-695. [PMID: 33817710 PMCID: PMC8112746 DOI: 10.47162/rjme.61.3.07] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Infantile hemangiomas (IHs) are the most frequent pediatric benign vascular tumors, with a reported incidence of 5% to 10%. They have self-limiting evolution pattern divided into a growth phase in the first 12 months and a regression one, that may take up to 10 years. Occasionally, hemangiomas might lead to local or systemic complications, depending on their morphological characteristics. The first line of treatment is β-blockers, such as Propranolol, Timolol, Nadolol, administered either locally or systemically. Newer therapeutic strategies involving laser therapy and angiotensin-converting enzyme inhibitors are being studied, while older treatment modalities like corticosteroids, Imiquimod, Vincristine, Bleomycin and Interferon-α have become second line therapy options. Before establishing the appropriate treatment, clinical, histological, and imaging investigations are required.
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Affiliation(s)
- Alina Costina Luca
- Department of Morphofunctional Sciences I - Pathology, Department of Mother and Child Medicine - Pediatrics, Grigore T. Popa University of Medicine and Pharmacy, Iaşi, Romania; ,
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8
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Pope E. Commentary:Beta-blockers and sleep problems. Pediatr Dermatol 2021; 38:378-379. [PMID: 33870561 DOI: 10.1111/pde.14537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 01/13/2021] [Accepted: 01/19/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Elena Pope
- The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
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9
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Leung AKC, Lam JM, Leong KF, Hon KL. Infantile Hemangioma: An Updated Review. Curr Pediatr Rev 2021; 17:55-69. [PMID: 32384034 DOI: 10.2174/1573396316666200508100038] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Infantile hemangiomas are the most common vascular tumors of infancy, affecting up to 12% of infants by the first year of life. OBJECTIVE To familiarize physicians with the natural history, clinical manifestations, diagnosis, and management of infantile hemangiomas. METHODS A Pubmed search was conducted in November 2019 in Clinical Queries using the key term "infantile hemangioma". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews published within the past 20 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS The majority of infantile hemangiomas are not present at birth. They often appear in the first few weeks of life as areas of pallor, followed by telangiectatic or faint red patches. Then, they grow rapidly in the first 3 to 6 months of life. Superficial lesions are bright red, protuberant, bosselated, or with a smooth surface, and sharply demarcated. Deep lesions are bluish and dome-shaped. Infantile hemangiomas continue to grow until 9 to 12 months of age, at which time the growth rate slows down to parallel the growth of the child. Involution typically begins by the time the child is a year old. Approximately 50% of infantile hemangiomas will show complete involution by the time a child reaches age 5; 70% will have disappeared by age 7; and 95% will have regressed by 10 to 12 years of age. The majority of infantile hemangiomas require no treatment. Treatment options include oral propranolol, topical timolol, and oral corticosteroids. Indications for active intervention include hemorrhage unresponsive to treatment, impending ulceration in areas where serious complications might ensue, interference with vital structures, life- or function-threatening complications, and significant disfigurement. CONCLUSION Treatment should be individualized, depending upon the size, rate of growth, morphology, number, and location of the lesion (s), existing or potential complications, benefits and adverse events associated with the treatment, age of the patient, level of parental concern, and the physician's comfort level with the various treatment options. Currently, oral propranolol is the treatment of choice for high-risk and complicated infantile hemangiomas. Topical timolol may be considered for superficial infantile hemangiomas that need to be treated and for complicated infantile hemangiomas in patients at risk for severe adverse events from oral administration of propranolol.
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Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kin F Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam L Hon
- Department of Paediatrics, The Chinese University of Hong Kong, and Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong
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10
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Theiler M, Knöpfel N, von der Heydt S, Schwieger-Briel A, Luchsinger I, Smith A, Kernland-Lang K, Waelchli R, Neuhaus K, Kohler M, Gnannt R, Schoch SF, Weibel L, Kurth S. Sleep behavior of infants with infantile hemangioma treated with propranolol-a cohort study. Eur J Pediatr 2021; 180:2655-2668. [PMID: 34143243 PMCID: PMC8285307 DOI: 10.1007/s00431-021-04147-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/01/2021] [Accepted: 06/03/2021] [Indexed: 11/30/2022]
Abstract
Sleep problems are frequently reported in infants treated with propranolol for infantile hemangiomas, possibly serving as a marker for a negative impact on central nervous system function. In this cohort study, we objectively investigate the sleep behavior of infants with infantile hemangiomas on propranolol compared to a healthy, untreated control group. Sleep of propranolol-treated infants and controls was investigated using ankle actigraphy and a 24-h diary for 7-10 days at ages 3 and 6 months. The main outcome measures were the Number of Nighttime Awakenings and Sleep Efficiency. The main secondary outcome measures included 24-hour Total Sleep, daytime sleep behavior, and parent-rated infant sleep quality and behavioral development based on the Brief Infant Sleep Questionnaire (BISQ) and the age-appropriate Ages-and-Stages Questionnaire (ASQ), respectively. Fifty-four term-born infants were included in each cohort. No group difference in any investigated parameter was seen at age 3 months. At age 6 months, the propranolol group exhibited a decrease in Sleep Efficiency and a trend towards an increased Number of Nighttime Awakenings compared to the control group. Treated infants at 6 months also had shorter daytime waking periods. 24-hour Total Sleep was unaffected by propranolol. No negative impact of propranolol on subjective sleep quality and behavioral development was noted.Conclusion: Propranolol exerts a measurable yet mild impact on objectively assessed infants' sleep measures. Behavioral developmental scores were unaffected. Our results support propranolol as first-line therapy for complicated infantile hemangiomas. What is Known: • Sleep disorders are frequently reported in infants with infantile hemangiomas treated with propranolol and often lead to treatment discontinuation. • Investigations of the sleep pattern in this patient group using objective measures are lacking. What is New: • The sleep pattern of propranolol-treated infants is assessed using actigraphy and a 24-h sleep diary and compared to healthy, untreated controls. • Propranolol leads to a decreased sleep efficiency at night and an increased demand of daytime sleep, yet effects are mild overall.
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Affiliation(s)
- Martin Theiler
- Pediatric Skin Center, Dermatology Department, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland. .,Vascular Anomalies Board Zurich, University Children's Hospital Zurich, Zurich, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Nicole Knöpfel
- Pediatric Skin Center, Dermatology Department, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland. .,Vascular Anomalies Board Zurich, University Children's Hospital Zurich, Zurich, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Susanne von der Heydt
- Department of Pediatric Surgery, Charité University Medicine, Virchow Medical Center, Berlin, Germany
| | - Agnes Schwieger-Briel
- Pediatric Skin Center, Dermatology Department, University Children’s Hospital Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland ,Vascular Anomalies Board Zurich, University Children’s Hospital Zurich, Zurich, Switzerland ,Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Isabelle Luchsinger
- Pediatric Skin Center, Dermatology Department, University Children’s Hospital Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland ,Vascular Anomalies Board Zurich, University Children’s Hospital Zurich, Zurich, Switzerland ,Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Alexandra Smith
- Division of Pediatric Dermatology, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Regula Waelchli
- Pediatric Skin Center, Dermatology Department, University Children’s Hospital Zurich, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland ,Vascular Anomalies Board Zurich, University Children’s Hospital Zurich, Zurich, Switzerland ,Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Kathrin Neuhaus
- Vascular Anomalies Board Zurich, University Children’s Hospital Zurich, Zurich, Switzerland ,Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland ,Pediatric Skin Center, Division of Plastic and Reconstructive Surgery, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Malcolm Kohler
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Ralph Gnannt
- Vascular Anomalies Board Zurich, University Children’s Hospital Zurich, Zurich, Switzerland ,Children’s Research Center, University Children’s Hospital Zurich, Zurich, Switzerland ,Division of Pediatric Interventional Radiology, Department of Diagnostic Imaging, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Sarah F. Schoch
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland ,Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, Switzerland
| | - Lisa Weibel
- Pediatric Skin Center, Dermatology Department, University Children's Hospital Zurich, Steinwiesstrasse 75, CH-8032, Zurich, Switzerland. .,Vascular Anomalies Board Zurich, University Children's Hospital Zurich, Zurich, Switzerland. .,Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Salome Kurth
- Department of Pulmonology, University Hospital Zurich, Zurich, Switzerland. .,Center of Competence Sleep & Health Zurich, University of Zurich, Zurich, Switzerland. .,Department of Psychology, University of Fribourg, 1700, Fribourg, Switzerland.
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11
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Qiao J, Lin J, Zhang D, Li J, Chen C, Yu H, Li X, Fang B. Efficacy of Combined Topical Timolol and Oral Propranolol for Treating Infantile Hemangioma: A Meta-Analysis of Randomized Controlled Trials. Front Pharmacol 2020; 11:554847. [PMID: 33132908 PMCID: PMC7578425 DOI: 10.3389/fphar.2020.554847] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/31/2020] [Indexed: 11/21/2022] Open
Abstract
Background Oral propranolol has become the first-line treatment for infantile hemangioma (IH). However, combined therapy with topical timolol and oral propranolol has been proposed as a more effective IH treatment strategy. We aimed to compare the safety and efficacy of topical timolol, oral propranolol, and their combination for treating IH in a meta-analysis. Methods Relevant randomized controlled trials (RCTs) were obtained after searching the PubMed, Embase, Cochrane’s Library, China National Knowledge Infrastructure, and WanFang databases. A random-effect model was used to pool the results. Results Eight RCTs with 759 patients with IH were included in this meta-analysis. Treatment with topical timolol alone showed a similar response rate compared to oral propranolol (risk ratio [RR] = 0.97, p = 0.63), but resulted in fewer adverse events (RR = 0.36, p = 0.002). Combined treatment with topical timolol and oral propranolol showed a favorable response rate compared to treatment with oral propranolol (RR = 1.14, p = 0.03) or topical timolol (RR = 1.36, p = 0.01) alone. Moreover, combined treatment showed similar risks of adverse events compared to oral propranolol (RR = 0.80, p = 0.24) or topical timolol (RR = 1.31, p = 0.25) alone. Conclusions Combined treatment with topical timolol and oral propranolol may be more effective than either single treatment strategy in patients with IH. Topical timolol alone conferred similar efficacy for IH compared to oral propranolol, but with less incidence of adverse events.
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Affiliation(s)
- Junbo Qiao
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junjie Lin
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dexin Zhang
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junhua Li
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Changkuan Chen
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongye Yu
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaodi Li
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Bin Fang
- Department of Hemangioma Surgery, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Xerfan EMS, Andersen ML, Facina AS, Tufik S, Tomimori J. Sleep disturbances as an adverse effect of propranolol use in children with infantile hemangioma. World J Pediatr 2020; 16:537-538. [PMID: 32016783 DOI: 10.1007/s12519-019-00335-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 12/30/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ellen M S Xerfan
- Programa de Pós-Graduação em Medicina Translacional, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Departamento de Dermatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Monica L Andersen
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.
| | - Anamaria S Facina
- Departamento de Dermatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Sergio Tufik
- Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Jane Tomimori
- Programa de Pós-Graduação em Medicina Translacional, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil.,Departamento de Dermatologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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13
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Scharf MM, Zimmermann M, Wilhelm F, Stroe R, Waldhoer M, Kolb P. A Focus on Unusual ECL2 Interactions Yields β 2 -Adrenergic Receptor Antagonists with Unprecedented Scaffolds. ChemMedChem 2020; 15:882-890. [PMID: 32301583 PMCID: PMC7318225 DOI: 10.1002/cmdc.201900715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/11/2020] [Indexed: 11/15/2022]
Abstract
The binding pockets of aminergic G protein-coupled receptors are often targeted by drugs and virtual screening campaigns. In order to find ligands with unprecedented scaffolds for one of the best-investigated receptors of this subfamily, the β2 -adrenergic receptor, we conducted a docking-based screen insisting that molecules would address previously untargeted residues in extracellular loop 2. We here report the discovery of ligands with a previously undescribed coumaran-based scaffold. Furthermore, we provide an analysis of the added value that X-ray structures in different conformations deliver for such docking screens.
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Affiliation(s)
- Magdalena M. Scharf
- Department of Pharmaceutical ChemistryPhilipps-University MarburgMarbacher Weg 635037MarburgGermany
| | | | - Florian Wilhelm
- InterAx BiotechPARK innovAARE5234VilligenSwitzerland
- Department of Biosystems Science and Engineering ETHETH ZürichMattenstrasse 264058BaselSwitzerland
| | - Raimond Stroe
- InterAx BiotechPARK innovAARE5234VilligenSwitzerland
- Department of Drug Design and PharmacologyUniversity of CopenhagenUniversitetsparken 22100CopenhagenDenmark
| | | | - Peter Kolb
- Department of Pharmaceutical ChemistryPhilipps-University MarburgMarbacher Weg 635037MarburgGermany
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14
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Chen ZY, Wang QN, Zhu YH, Zhou LY, Xu T, He ZY, Yang Y. Progress in the treatment of infantile hemangioma. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:692. [PMID: 31930093 PMCID: PMC6944559 DOI: 10.21037/atm.2019.10.47] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023]
Abstract
Infantile hemangioma (IH) is a common benign tumor, which mostly resolves spontaneously; however, children with high-risk IH need treatment. Currently, the recognized first-line treatment regimen for IH is oral propranolol, but research on the pathogenesis of IH has led to the identification of new therapeutic targets, which have shown good curative effects, providing more options for disease treatment. This article summarizes the applications of different medications, dosages, and routes of administration for the treatment of IH. In addition to drug therapy, this article also reviews current therapeutic options for IH such as laser therapy, surgical treatment, and observation. To provide the best treatment, therapeutic regimens for IH should be selected based on the child's age, the size and location of the lesion, the presence of complications, the implementation conditions, and the potential outcomes of the treatment.
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Affiliation(s)
- Zhao-Yang Chen
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Qing-Nan Wang
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Yang-Hui Zhu
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Ling-Yan Zhou
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Ting Xu
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Zhi-Yao He
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
| | - Yang Yang
- Department of Pharmacy, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center of Biotherapy, Chengdu 610041, China
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