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Severe hypoglycemia in propranolol treatment for infantile hemangiomas

BACKGROUND: Infantile hemangioma (IH), formerly termed strawberry hemangioma, is a benign vascular tumor caused by capillary endothelial cell proliferation. The tumor regresses after 1 year of age, but sequelae occur in approximately half of the patients without systemic treatment. Propranolol (PPL)...

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Autores principales: Morimoto, Akira, Ozeki, Michio, Sasaki, Satoru, Baba, Naoko, Kuwano, Yoshihiro, Kaneko, Tsuyoshi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9541900/
https://www.ncbi.nlm.nih.gov/pubmed/35972062
http://dx.doi.org/10.1111/ped.15278
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author Morimoto, Akira
Ozeki, Michio
Sasaki, Satoru
Baba, Naoko
Kuwano, Yoshihiro
Kaneko, Tsuyoshi
author_facet Morimoto, Akira
Ozeki, Michio
Sasaki, Satoru
Baba, Naoko
Kuwano, Yoshihiro
Kaneko, Tsuyoshi
author_sort Morimoto, Akira
collection PubMed
description BACKGROUND: Infantile hemangioma (IH), formerly termed strawberry hemangioma, is a benign vascular tumor caused by capillary endothelial cell proliferation. The tumor regresses after 1 year of age, but sequelae occur in approximately half of the patients without systemic treatment. Propranolol (PPL) is currently the first‐line therapeutic agent in Japan as well as in Western countries. It is not commonly known that PPL may induce severe hypoglycemia, in addition to cardiovascular and respiratory side effects. METHODS: We retrospectively analyzed patients with severe PPL‐induced hypoglycemia in the 3 years since the launch of Hemangiol®, a PPL preparation specific for IH, in Japan in 2016. RESULTS: The incidence of severe hypoglycemia and of hypoglycemic convulsions following PPL treatment was estimated to be 0.54% and 0.35%, respectively. The incidence of hypoglycemic convulsions appeared to be higher in Japan than in Western countries. Severe hypoglycemia was common in infants aged >1 year, when PPL was used for ≥6 months. Severe hypoglycemia often develops from 05:00 a.m. to 09:00 a.m. and is frequently associated with prolonged periods of fasting, poor feeding, or poor physical conditions. CONCLUSION: To avoid the risk of hypoglycemia, the treatment should be initiated by 6 months of age during the proliferative phase at the latest, and should not be extended indiscriminately beyond 1 year of age. Guardians should be advised not to administer PPL on an empty stomach, in the presence of poor feeding, or who are in poor physical condition, not to prolong fasting after PPL administration, and to monitor the child's condition immediately after he or she wakes up.
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spelling pubmed-95419002022-10-14 Severe hypoglycemia in propranolol treatment for infantile hemangiomas Morimoto, Akira Ozeki, Michio Sasaki, Satoru Baba, Naoko Kuwano, Yoshihiro Kaneko, Tsuyoshi Pediatr Int Original Articles BACKGROUND: Infantile hemangioma (IH), formerly termed strawberry hemangioma, is a benign vascular tumor caused by capillary endothelial cell proliferation. The tumor regresses after 1 year of age, but sequelae occur in approximately half of the patients without systemic treatment. Propranolol (PPL) is currently the first‐line therapeutic agent in Japan as well as in Western countries. It is not commonly known that PPL may induce severe hypoglycemia, in addition to cardiovascular and respiratory side effects. METHODS: We retrospectively analyzed patients with severe PPL‐induced hypoglycemia in the 3 years since the launch of Hemangiol®, a PPL preparation specific for IH, in Japan in 2016. RESULTS: The incidence of severe hypoglycemia and of hypoglycemic convulsions following PPL treatment was estimated to be 0.54% and 0.35%, respectively. The incidence of hypoglycemic convulsions appeared to be higher in Japan than in Western countries. Severe hypoglycemia was common in infants aged >1 year, when PPL was used for ≥6 months. Severe hypoglycemia often develops from 05:00 a.m. to 09:00 a.m. and is frequently associated with prolonged periods of fasting, poor feeding, or poor physical conditions. CONCLUSION: To avoid the risk of hypoglycemia, the treatment should be initiated by 6 months of age during the proliferative phase at the latest, and should not be extended indiscriminately beyond 1 year of age. Guardians should be advised not to administer PPL on an empty stomach, in the presence of poor feeding, or who are in poor physical condition, not to prolong fasting after PPL administration, and to monitor the child's condition immediately after he or she wakes up. John Wiley and Sons Inc. 2022-08-16 2022 /pmc/articles/PMC9541900/ /pubmed/35972062 http://dx.doi.org/10.1111/ped.15278 Text en © 2022 The Authors. Pediatrics International published by John Wiley & Sons Australia, Ltd on behalf of Japan Pediatric Society. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Articles
Morimoto, Akira
Ozeki, Michio
Sasaki, Satoru
Baba, Naoko
Kuwano, Yoshihiro
Kaneko, Tsuyoshi
Severe hypoglycemia in propranolol treatment for infantile hemangiomas
title Severe hypoglycemia in propranolol treatment for infantile hemangiomas
title_full Severe hypoglycemia in propranolol treatment for infantile hemangiomas
title_fullStr Severe hypoglycemia in propranolol treatment for infantile hemangiomas
title_full_unstemmed Severe hypoglycemia in propranolol treatment for infantile hemangiomas
title_short Severe hypoglycemia in propranolol treatment for infantile hemangiomas
title_sort severe hypoglycemia in propranolol treatment for infantile hemangiomas
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9541900/
https://www.ncbi.nlm.nih.gov/pubmed/35972062
http://dx.doi.org/10.1111/ped.15278
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