This is a retrospective review of 104 patients treated for infantile haemangioma between January 2009 and July 2012. All patients underwent pretesting either with protocol A (administration of test dose with routine observations) or protocol B (cardiology clinic assessment, including two dimensional echocardiography without test dose). The aim of this study is to analyse treatment initiation in a large tertiary children’s hospital in the UK and investigate the value of pretreatment testing in predicting commonly seen adverse reactions of propranolol. It was found that 38.5% (40/104) of patients developed adverse reactions during treatment; however, there were no severe or life-threatening reactions. Protocol A has a sensitivity of 0 and specificity of 0.95 and Protocol B has a sensitivity of 0.07 (95% confidence interval 0 to 0.34) and specificity of 0.86 (95% confidence intervals between 0.63 and 0.96). Eight of these patients (7.7%) had multiple adverse reactions. The majority of adverse reactions were breathing-related problems (12/104 (11.5%)), cold extremities (10/104 (9.6%)), gastrointestinal (watery diarrhea; 10/104 (9.6%)) and sleep-related changes (night terrors; 9/104 (8.7%)). The authors concluded that the predictive values of both protocols for the commonly observed adverse reactions are low. In this series, there is no evidence to suggest that routine pretreatment testing before propranolol initiation is of any value in otherwise healthy children.

Predicting complications with pretreatment testing in infantile haemangioma treated with oral propranolol.
Tang LYH, Hing JWG, Tang JYM, et al.
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Jonathan Chan

Royal Hallamshire Hospital, Sheffield, UK.

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