Infantile hemangiomas are common vascular tumours in infants. Propranolol is currently accepted as the first choice if systemic treatment is needed. Propranolol has an excellent record of safety in young children, but some concerns have been raised about possible longer-term neurocognitive effects and five recent unexpected infant deaths have been reported. An alternative beta blocker, atenolol, may be as effective at hemangioma treatment and may have a better side effect profile.
To report the efficacy, safety, and side effect profile of oral atenolol for infantile hemangiomas.
We conducted a prospective observational study of 219 infants with infantile hemangiomas who were prescribed oral atenolol (1 mg/kg bd) as outpatients. The primary outcome measure was the response of the hemangioma.
The median age at commencement was 3.6 months. The median duration of treatment was 8.5 months. An excellent response was seen in 59.0% of patients, good response in 30.5%, and poor response in 10.5%. There was no significant difference in the response to atenolol with location or type of hemangioma or age at the commencement of atenolol. Possible side effects were reported in 8% of patients, and sleep disturbance in 3%. No infant had any reported hypoglycaemic or cardiovascular events attributable to atenolol.
Atenolol is effective in treating infantile hemangiomas in an outpatient setting with 90% of patients having a good or excellent response to treatment. Atenolol appears to have a more favorable side effect profile than propranolol. It is reasonable to consider atenolol as first-line therapy for infantile hemangiomas needing oral treatment.