BACKGROUND/OBJECTIVES Infantile hemangiomas (IH) are the most common soft-tissue tumors in childhood, occurring in up to 1 in 10 infants. Oral propranolol has been well established as the first-line treatment of complicated hemangiomas; however, variability in the administration protocol remains. We sought to evaluate our current propranolol treatment protocols to determine if the level of monitoring and follow-up predicts immediate or future adverse events by comparing one in-person visit vs two in-person visits versus teledermatology for treatment initiation and dose escalation. METHODS We analyzed retrospective data on 279 patients diagnosed with IH and treated with oral propranolol on an in-person or virtual telemedicine outpatient basis from January 01, 2015 through May 31, 2020. Data were collected via chart review on all aspects of patient demographics, treatment indication, treatment initiation, adverse events, and follow-up visits. RESULTS Two monitoring visits (Protocol 1) versus one (Protocol 2) was not associated with decreased adverse outcomes (P = .255). The odds of having an adverse event in Protocol 1 compared to Protocol 2 was insignificant (OR: 0.64; CI: 0.30-1.38). The most frequently reported adverse event among patients in both protocols was sleep disturbance. However, it did not vary significantly among the groups (P = .980, OR: 0.98, CI: 0.35-2.69). CONCLUSION Prolonged in-office monitoring of propranolol initiation and dose escalation (Protocol 1) may not be necessary for the setting of adequate prescreening as it does not predict immediate or future adverse events.
Is prolonged monitoring necessary? An updated approach to infantile hemangioma treatment with oral propranolol.