E. Sideris1,2, J. Relic1,2, J. Bale3
Oral propranolol is ﬁrst line systemic treatment for infan- tile haemangioma (IH). No long-term adverse effects on cognition, growth or development in propranolol-exposed infants are reported despite concerns due to its ability to cross the blood-brain barrier.1 Uncommonly reported instances of reversible weight-loss, cognition and developmental change, including decline or delay in walking, whilst taking propranolol do exist.2 We report another such case of weight-loss and central nervous system (CNS) effects of behaviour change, lethargy and decline in cogni- tive and functional development in a nine-month-old girl taking oral propranolol for IH. She regained her prior level of activity, cognitive function and development within weeks of propranolol cessation and slowly regained weight. It is unknown what causes weight loss in such cases.2
Although uncommon, this case suggests monitoring of cog- nition and developmental changes in children whilst on propranolol for IH is needed. The possibility of such reac- tions and weight-loss should be included in information provided to parents when starting their child on propra- nolol, so they can watch for any concerning changes. If necessary, atenolol and nadolol are efﬁcacious alternatives for IH treatment without the ability to cause such CNS effects.
1. Hagen, R, Ghareeb, E, Jalali, O, Zinn, Z, ‘Infantile heman- giomas: what have we learned from propranolol?’ Current Opin- ion in Pediatrics, 2018;30(4):499–504.
2. Hu, L, Zhou, B, Huang, H et al, ‘Effects of systemic propranolol treatment on physical growth of patients with infantile heman- giomas’, The Journal of Dermatology, 2016;43(10):1160–1166.