Treatment of infantile subglottic hemangioma with oral propranolol

Abstract

Infantile subglottic hemangioma (SH) can cause biphasic stridor, respiratory distress and even life-threatening airway compromise. Treatment of SH in infants has traditionally been characterized as a challenging situation with multiple therapeutic options without consensus as to which one is the best and with risks of severe side-effects. Four infants with SH were treated with propranolol. Treatment with oral propranolol resulted in resolution of symptoms within 2 days, followed by complete recovery. Propranolol appears to be an effective treatment for SH and should be used as a first-line treatment for SH when intervention is required.

Subglottic hemangioma masquerading as croup and treated successfully with oral propranolol

“…The condition often gets confused with croup as both have a similar time of onset and also the fact that SGH often improves transiently with adrenaline nebulization. [ 4 ] In this index case, also the initial diagnosis was croup and she responded transiently with adrenaline nebulization and dexamethasone.…”

Efficacy and rebound rates in propranolol‐treated subglottic hemangioma: A literature review

“…The primary exclusion criterion was the use of any intervention or medical therapy prior to propranolol. Twenty‐four studies published between 2009 and 2016 met all inclusion criteria to be included in the final review and analysis . Although our search began with articles in 2008, the first study meeting our inclusion criteria of primary treatment with propranolol was not published until 2009.…”

Neonatal Airway Abnormalities

“…If the airway is not compromised, hemangiomas can be treated with a "watch and wait" approach as they spontaneously regress over years. Presenting symptoms include biphasic stridor, respiratory distress, and difficulty feeding [45][46][47]. Importantly, the infant's cry will be normal and swallowing will be unaffected unless there is an additional airway lesion [47].…”

“…Presenting symptoms include biphasic stridor, respiratory distress, and difficulty feeding [ 45 , 46 , 47 ]. Importantly, the infant’s cry will be normal and swallowing will be unaffected unless there is an additional airway lesion [ 47 ].…”

“…Treatment of subglottic hemangioma depends on the severity of the airway obstruction. Steroids, B-blockers including propranolol, endoscopic laser resection, tracheostomy, and open excision are treatments for subglottic hemangioma [ 45 , 46 , 47 ]. If the airway is not compromised, hemangiomas can be treated with a “watch and wait” approach as they spontaneously regress over years.…”