Infantile
hemangiomas (IH) are common benign vascular
tumors seen in children. Although the majority will improve spontaneously without treatment, a small subset will require
therapy due to a variety of complications. Less than a decade ago,
propranolol replaced
corticosteroids as first-line treatment for most IH and it has proven to be a relatively safe, effective
therapy. After initiation of
propranolol, most
hemangiomas show evidence of significant improvement relatively rapidly, often within days. Although
propranolol is generally felt to have a more limited side-effect profile than systemic
corticosteroids, its use has been infrequently associated with adverse events, including sleep disturbances, acrocyanosis,
hypotension,
bradycardia, respiratory events, and
hypoglycemia. Rarely,
hypoglycemic seizures have been reported, usually occurring in the setting of prolonged fasting.