Diagnosis and Management of Infantile Hemangioma

Table 37. Strength of evidence for harms of beta-blockers (continued)
Intervention
Timolol
Outcome
Study Design
Quality and Number of
Studies (N Total)
Lack of harms
RCT: 1 good, 1 poor 14,104
(71)
Cohort studies: 1 good, 3
poor 103,105,106,144 (287)
Study
Limitations
Consistency Directness Precision
Reporting
Bias
Finding
Strength of Evidence
Grade
Medium Unknown Direct Imprecise Undetected No harms observed with
timolol in 5 comparative
studies and 1 case series.
Shortness of breath and
insomnia observed in 1 of
30 children in one
comparative study. 14
Nadolol
Case series: 1 poor 159 (25)
Clinically important harms
(hypotension, bradycardia,
bronchospasm,
hypoglycemia)
Cohort studies: 1 poor 101
(19)
Minor harms (cold
extremities, diarrhea, sleep
changes)
Cohort studies: 1 poor 101 (19)
Low SOE for lack of
association of timolol with
harms based on few
studies.
High Unknown Direct Imprecise NA Harms of nadolol reported
in 10%-20% of children.
Insufficient SOE for
association with clinically
important harms given
single, small poor quality
cohort study.
High Unknown Direct Imprecise NA Harms of nadolol reported
in 10%-50% of children.
Insufficient SOE for
association with minor
harms given single, small
poor quality study.
91