Airway hemangiomas (AHs), which are common in infant airways, often cause significant upper airway obstruction. The various therapies used for AH have limitations and complications. Propranolol may have a potential role in its treatment, since it leads to regression or stabilization of cutaneous infantile hemangiomas. To date, only 4 previous case reports (7 patients) in which propranolol was used for AH have been published. Based on encouraging preliminary data on propranolol use for AH treatment, our goal was to further investigate propranolol as an effective initial treatment of upper AHs that cause significant obstruction symptoms. In this retrospective case series, we reviewed the medical records of 5 consecutive pediatric patients with AH (glottic and subglottic) treated with propranolol at a tertiary care children's hospital. All 5 patients were 2 months of age at the time of hemangioma diagnosis and had stridor and physical signs of severe upper airway obstruction. Hemangioma was diagnosed by flexible laryngoscopy or flexible bronchoscopy. All patients received propranolol 2 mg/kg/day and showed significant relief of obstruction symptoms within 24 hours of treatment initiation. All patients tolerated propranolol without significant cardiovascular complications. Outcomes from this case series, in conjunction with available case reports in the literature, suggest that propranolol is a safe initial treatment for symptomatic upper AH.
Airway hemangiomas (AHs), which are common in infant airways, often cause significant upper airway obstruction. The various therapies used for AH have limitations and complications. Propranolol may have a potential role in its treatment, since it leads to regression or stabilization of cutaneous infantile hemangiomas. To date, only 4 previous case reports (7 patients) in which propranolol was used for AH have been published. Based on encouraging preliminary data on propranolol use for AH treatment, our goal was to further investigate propranolol as an effective initial treatment of upper AHs that cause significant obstruction symptoms. In this retrospective case series, we reviewed the medical records of 5 consecutive pediatric patients with AH (glottic and subglottic) treated with propranolol at a tertiary care children's hospital. All 5 patients were 2 months of age at the time of hemangioma diagnosis and had stridor and physical signs of severe upper airway obstruction. Hemangioma was diagnosed by flexible laryngoscopy or flexible bronchoscopy. All patients received propranolol 2 mg/kg/day and showed significant relief of obstruction symptoms within 24 hours of treatment initiation. All patients tolerated propranolol without significant cardiovascular complications. Outcomes from this case series, in conjunction with available case reports in the literature, suggest that propranolol is a safe initial treatment for symptomatic upper AH.
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IntroductionChildhood interstitial and diffuse lung disease (chILD) encompasses a broad spectrum of rare disorders. The Children's Interstitial and Diffuse Lung Disease Research Network (chILDRN) established a prospective registry to advance knowledge regarding etiology, phenotype, natural history, and management of these disorders.MethodsThis longitudinal, observational, multicenter registry utilizes single‐IRB reliance agreements, with participation from 25 chILDRN centers across the U.S. Clinical data are collected and managed using the Research Electronic Data Capture (REDCap) electronic data platform.ResultsWe report the study design and selected elements of the initial Registry enrollment cohort, which includes 683 subjects with a broad range of chILD diagnoses. The most common diagnosis reported was neuroendocrine cell hyperplasia of infancy, with 155 (23%) subjects. Components of underlying disease biology were identified by enrolling sites, with cohorts of interstitial fibrosis, immune dysregulation, and airway disease being most commonly reported. Prominent morbidities affecting enrolled children included home supplemental oxygen use (63%) and failure to thrive (46%).ConclusionThis Registry is the largest longitudinal chILD cohort in the United States to date, providing a powerful framework for collaborating centers committed to improving the understanding and treatment of these rare disorders.
Postoperative pain after pediatric tonsillectomy. 96 patients aged 2-14 in a tertiary care children hospital in Chihuahua, Mexico. 48 control patients were injected with a 1.5 ml saline injection, and 48 patients injected with a 1.5 ml mixture of lidocaine 2% plus epinephrine 1/200,000, fentanyl 50 mg, clonidine 150 mcg/ml pre incisional. All tonsillectomies were done by the same surgeon, with a monopolar technique, outpatient procedure. Patients' parents were instructed to complete an 8 hour basic evaluation of pain day 0 through day 7 and written down on a leaflet (scale 0-10), with the Wong faces pain scale, diet ingested on each meal from day 0 through day 7. The Mann-Whitney U test was used to determine the statistical significance for samples. Nominal data of groups were compared by using the chi-square or Fischer's exact test. P value of ϭ0.0001 was considered significant. Independent variables: Lingual nerve blockage, nominal scale, qualitative type. RESULTS: Charts of 122 patients were reviewed. 26 were discarded due to incorrect completion. 96 charts were included. Regarding pain was a significant difference in the infiltration group with a 2 points reduction from day 0 through day 4 (pϭ0.0001). Diet was started 24 hours before control group. There was a clinical significance. Parent satisfaction had a better score in the local anesthetic group. CONCLUSION: Pre-incisional infiltration of an anesthetic mixture combined with general anesthesia reduces significantly post-tonsillectomy pain in children and provides a much faster return to normal activity compared to general anesthesia alone or in combination with placebo infiltration. Injection in the tonsillar fossae is a simple and safe method.
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