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Püttgen KB, Hansen LM, Lauren C, Stefanko N, Mathes E, Olsen GM, Tollefson MM, Adams D, Baselga E, Chamlin S, Corey K, Frascari FF, Frieden IJ, Galligan ER, Gupta D, Haggstrom A, Horii K, Hornik CP, Klajn J, Liberman L, Mancini A, Mannschreck D, McGinness A, McCuaig C, Newell B, Nguyen H, Nopper A, Oyesanya T, Powell J, Reynolds M, Rios M, Siegel DH, Ward K, Garzon MC, Frommelt P, Drolet BA. Limited utility of repeated vital sign monitoring during initiation of oral propranolol for complicated infantile hemangioma. J Am Acad Dermatol 2021; 85:345-352. [PMID: 32289387 DOI: 10.1016/j.jaad.2020.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 04/03/2020] [Accepted: 04/04/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Initial propranolol recommendations for infantile hemangioma published in 2013 were intended as provisional best practices to be updated as evidence-based data emerged. METHODS A retrospective multicenter study was performed to evaluate utility of prolonged monitoring after first propranolol dose and escalation(s). Inclusion criteria included diagnosis of hemangioma requiring propranolol of greater than or equal to 0.3 mg/kg per dose, younger than 2 years, and heart rate monitoring for greater than or equal to 1 hour. Data collected included demographics, dose, vital signs, and adverse events. RESULTS A total of 783 subjects met inclusion criteria; median age at initiation was 112 days. None of the 1148 episodes of prolonged monitoring warranted immediate intervention or drug discontinuation. No symptomatic bradycardia or hypotension occurred during monitoring. Mean heart rate change from baseline to 1 hour was -8.19/min (±15.54/min) and baseline to 2 hours was -9.24/min (±15.84/min). Three preterm subjects had dose adjustments because of prescriber concerns about asymptomatic vital sign changes. No significant difference existed in pretreatment heart rate or in heart rate change between individuals with later adverse events during treatment and those without. CONCLUSION Prolonged monitoring for initiation and escalation of oral propranolol rarely changed management and did not predict future adverse events. Few serious adverse events occurred during therapy; none were cardiovascular.
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Affiliation(s)
| | | | | | | | - Erin Mathes
- University of California-San Francisco, San Francisco, California
| | | | | | | | | | - Sarah Chamlin
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Flora F Frascari
- University of California-San Francisco, San Francisco, California
| | - Ilona J Frieden
- University of California-San Francisco, San Francisco, California
| | | | - Deepti Gupta
- Seattle Children's Hospital/University of Washington School of Medicine, Seattle, Washington
| | | | | | | | - Justyna Klajn
- University of California-San Francisco, San Francisco, California
| | | | - Anthony Mancini
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Anelah McGinness
- University of California-San Francisco, San Francisco, California
| | | | | | | | - Amy Nopper
- University of Missouri, Kansas City, Missouri
| | - Tola Oyesanya
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julie Powell
- Sainte-Justine University Hospital Center, Montreal, Quebec, Canada
| | - Megan Reynolds
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Monica Rios
- Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Kendra Ward
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | | | - Beth A Drolet
- School of Medicine and Public Health, University of Wisconsin, Milwaukee, Wisconsin.
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Affiliation(s)
- Tola Oyesanya
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Anna L. Grossberg
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Ginette A. Okoye
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
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Abstract
Systematised epidermal naevi are hamartomas developing from neural ectoderm that can be quite extensive, typically with involvement of the face, neck, scalp, arms, legs and trunk. Involvement of the gastrointestinal tract is rare. We report on a 38-year-old Caucasian woman with systematised epidermal naevus syndrome who presented with previously undescribed involvement of the oesophagus, as well as the right side of her scalp, forehead, cheeks, chin, oral mucosa, neck, arms and trunk.
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Affiliation(s)
- Tola Oyesanya
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Emily Boozalis
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bernard A Cohen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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