Diagnosis and Management of Infantile Hemangioma

majority of studies to date have investigated the 2 mg/kg/day dosing regimen. Despite changes in
lesion size in many children receiving propranolol, some children do not appear to respond to
propranolol, but these children are not well-characterized to date.
In network meta-analysis, the mean expected clearance rate for oral propranolol was 95
percent (95% BCI: 88% to 99%) relative to 6 percent for placebo/observation arms (95% BCI:
1% to 11%); IH size reductions were greater in propranolol arms versus control in all individual
studies, thus we considered the SOE as high for greater effectiveness of propranolol compared
with placebo or observation based on individual comparisons and the meta-analysis.
Propranolol Versus Other Active Modalities
Ten studies compared propranolol to another modality including steroids, pulse dye laser
(PDL), bleomycin, or historical treatments. Studies comparing propranolol and steroids to reduce
IH size had conflicting findings. Propranolol was more effective than steroids in three studies,
while two others studies did not find effectiveness differed significantly between these
treatments. In network meta-analysis, pooling data from multiple studies, propranolol was
superior to oral steroids (95% clearance [95% BCI: 88% to 99%]) versus 43% clearance [95%
BCI: 22% to 66%]). These combined effects from individual studies and meta-analysis conferred
moderate SOE for superiority of propranolol over steroids at achieving clearance.
One additional retrospective cohort study assessing only vision outcomes reported no
significant differences between oral propranolol and intralesional steroids in improving
amblyopia, but children in the propranolol arm had a significantly shorter duration of therapy
(p