Table 2

Treatment protocol

Before starting propranolol
  • Full clinical history and examination including HR, BP and SpO2

  • Parents’ education and written information given

  • Clinical photography

  • ECHO and ECG in selected patients (please see table below)

ECGECG and ECHO
If the HR is below normal for age
History of arrhythmia or arrhythmia on examination
Family history of congenital heart condition, arrhythmia or maternal history of connective tissue disease
Patients with history, symptoms or signs of cardiovascular disease, including patients with suspected high output heart failure
Patients with large segmental haemangioma of the face and neck and suspected PHACE syndrome
Dosage regime
Week 11 mg/kg/day divided into three equal doses
Week 22 mg/kg/day divided into three equal doses
Patients with suspected PHACE syndrome0.5 mg/kg/day and very cautious increase of the dose in small increments until MRA excludes arterial anomalies of head and neck
Observation and monitoring
Weight >3.5 kg and no comorbiditiesBP and HR immediately before the dose and every 30 min for 2 h
Weight <3.5 kg and/or comorbiditiesBP and HR immediately before the dose and every 30 min for 4h or longer
Other investigations*
InvestigationsGroup of patients
Blood tests:
Thyroid function testLiver haemangioma
Parotid haemangioma
PHACE syndrome
Liver function testsLiver haemangioma
Full blood countBleeding haemangiomas
Abdominal ultrasoundMore than 10 cutaneous haemangiomas
Perianal and perineal haemangioma crossing the midline and/or extending into gluteal cleft
MRA brain and neckLarge segmental haemangioma of head and neck with suspected PHACE syndrome
MRI spinePlaque haemangioma in lumbosacral area crossing the midline or perianal/perineal haemangioma extending into gluteal cleft
Referrals
ENT teamSuspected airway haemangioma
Ophthalmology teamPeri-ocular haemangioma
Continuation of the treatment
Reviews4–6 weeks after starting treatment, then 3–4 monthly
IncrementsIncrements greater than 0.5 mg/kg/day should include monitoring of HR and BP for 2 h
Treatment stoppingUsually at 12–14 months of age but can be longer
Gradual dose reduction over 2–4 weeks
  • *Propranolol can be commenced while the investigations/results are pending.

  • BP, blood pressure; ECHO, echocardiogram; ENT, ear, nose and throat; HR, heart rate; MRA, magnetic resonance angiography.