PEDIATRIC OCCULAR HEMANGIOMA

Induction of systemic propranolol The consensus recommendation for target dose of propranolol is 1 to 3 mg/kg/d divided into 3 times daily dosing with a minimum of 6 hours between doses. The median dose reported in the literature is 2 mg/kg/d.

The final dose should be titrated up from a low starting point, with special attention paid to dose response. Initiation in an inpatient setting is recommended for infants of a corrected gestational age of 8 weeks or less, as well as those with comorbidities such as those described above, regardless of age

Baseline heart rate and blood pressure should be measured before initiation, and these measurements should be repeated at 1 and 2 hours after administration of the first dose (peak effect of propranolol being achieved 1–3 hours after administration). Dose response is most drastic after the first dose, so there is no further need to monitor vital signs after subsequent doses in patients more than 8 weeks of age with no comorbidities.

In addition to systemic b-blocker therapy, topical timolol has also been found efficacious in the treatment of superficial hemangiomasTypically, 0.5% timolol maleate drops, or 0.25% timolol maleate gel,39 is applied to lesions 2 to 3 times daily. This therapy was first described by Guo and Ni in 2010,39 and subsequent literature supports the finding that it is effective for more superficial lesions, even in cases of infants with PHACE syndrome.