The Outcome of Combination of Low Dose Oral Prednisolone and Oral Propranolol for the Treatment of Infantile Hemangioma
Objective: To determine the outcome of combination of low dose oral Prednisolone with oral propranolol for the treatment of infantile hemangioma. Study Design: Experimental Study Setting: Department of Neonatal & Pediatric Surgery, Plastic Surgery, Dermatology and Ophthalmology, Bahawal Victoria Hospital, Bahawalpur. Duration of Study: 7th January 2013 to 6th July 2013. Subjects and Methods: Seventy three cases fulfilling inclusion criteria were registered through Outpatient Departments of Neonatal & Pediatric surgery, plastic surgery, Dermatology and Ophthalmology, Bahawal Victoria Hospital, Bahawalpur. Diagnosis were confirmed by consultant pediatric Surgeon (assistant professor and above having 5 years experience) clinically and by Color Doppler ultrasonography (clustered dilated, tortuous blood vessels with Sluggish blood flow) by consultant radiologist (assistant professor and above having 5 years experience). Demographic history including age (in years) and sex (male or female) were taken. Approval from the hospital ethical committee was taken. Written informed consent was taken from the parents/guardians of the patients after discussing the risks and benefits of the drugs. All the patients received treatment with oral prednisolone in a dose of 1mg/kg/day and propranolol in a dose of 0.5 mg/kg/day twice a day (BID) and increase up to 1.5mg/kg/day BID within three days with close monitoring of heart rate, blood pressure and blood glucose as an inpatient. Treatment was given for 3 months to all patients then titer down for two weeks before cessation of treatment. In case of early response i.e, before 3 month, drugs were titer down for two weeks before cessation. The follow up of the patients were performed at 7th day after initiation of treatment, then 1st month and finally at 3rd month. Heart rate, blood pressure, random blood sugar and treatment compliance was checked during each visit along with outcome parameter i.e. response which was categorized as excellent, good, moderate, slight improvement or no effect taking good to excellent response as acceptable outcome by measuring the size of IHs in terms of maximum dimensions in millimeters by using 100 mm horizontal scale on photograph taking by using 12 mega pixel digital camera. All the information was collected on a specially designed proforma (attached). Results: In this study, 36.99%(n=27) had 1 year of age, 32.88%(n=24) had 2 years and 30.13%(n=22) had 3 years of age, mean+SD: 1.96+0.54 years, 53.42%(n=39) were male and 46.58%(n=34) were females, frequency of response of the treatment was recorded as 56.16%(n=41) had excellent, 23.29%(n=17) had good, 15.07%(n=11) had moderate response, 4.11%(n=3) had slight improvement and 1.37%(n=1) had no effect while frequency of acceptable outcome revealed as acceptable in 79.45%(n=58) while 20.55%(n=15) had not acceptable outcome. Conclusion: This study concludes that the combination of low dose oral propranolol with that of oral Prednisolone for the treatment of infantile hemangioma is effective and safe
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