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Great Ormond Street Hospital treatment guidelines for use of propranolol in infantile isolated subglottic haemangioma

  • Y Bajaj (a1), K Kapoor (a1), S Ifeacho (a1), C G Jephson (a1), D M Albert (a1), J I Harper (a2) and B E Hartley (a1)...



Treatment options for large subglottic haemangioma include steroids, laser ablation, open excision, tracheostomy and, more recently, propranolol. This article aims to present the Great Ormond Street Hospital guidelines for using propranolol to treat infantile isolated subglottic haemangioma by ENT surgeons.


The vascular malformations multidisciplinary team at Great Ormond Street Hospital has developed guidelines for treating infantile haemangioma with propranolol.


The Great Ormond Street Hospital guidelines for propranolol treatment for infantile subglottic haemangioma include investigation, treatment and follow up. Propranolol is started at 1 mg/kg/day divided into three doses, increasing to 2 mg/kg/day one week later. On starting propranolol and when increasing the dose, the pulse rate and blood pressure must be checked every 30 minutes for the first 2 hours. Lesion response to treatment is assessed via serial endoscopy.


Recent reports of dramatic responses to oral propranolol in children with haemangioma and acute airway obstruction have led to increased use. We advocate caution, and have developed guidelines (including pre-treatment investigation and monitoring) to improve treatment safety. Propranolol may in time prove to be the best medical treatment for subglottic haemangioma, but at present is considered to be still under evaluation.


Corresponding author

Address for correspondence: Mr Yogesh Bajaj, 2 Tall Trees, Leeds LS17 7WA, UK Fax: +44 (0)113 266 3305 E-mail:


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1Chang, LC, Haggstrom, AN, Drolet, BA. Growth characteristics of infantile hemangiomas: implications for management. Pediatrics 2008;122:360–7
2Wiatrak, BJ, Reilly, JS, Seid, AB, Pransky, SM, Castillo, JV. Open surgical excision of subglottic hemangioma in children. Int J Pediatr Otorhinolaryngol 1996;34:191206
3McGill, TJ. Vascular anomalies of the head and neck. In: Wetmore, RF, Muntz, HR, McGill, TJ, eds. Pediatric Otolology: Principles and Practice Pathoways. New York: Thieme Medical Publishers, 2000;87100
4Brodsky, L, Yoshpen, N, Ruben, RJ. Clinical-pathological correlates of congenital subglottic haemangiomas. Ann Otol Rhinol Laryngol Suppl 1983;205:418
5Sie, KCY, McGill, T, Healy, GB. Subglottic hemangioma: ten years' experience with the carbon dioxide laser. Ann Otol Rhinol Laryngol 1994;103:167–72
6Bajaj, Y, Hartley, BEJ, Albert, DM, Bailey, CM. Subglottic haemangioma in children: experience with open surgical excision. J Laryngol Otol 2006;120:1033–7
7Pierce, MK. Subglottic hemagiomas in infants – a presumptive clinical test for diagnosis. Ann Otol Rhinol Laryngol 1962;71:1057–62
8George, ME, Sharma, V, Jacobson, J, Simon, S, Nopper, AJ. Adverse effects of systemic glucocorticoid therapy in infants with hemangiomas. Arch Dermatol 2004;140:963–9
9Buckmiller, LM, Munson, PD, Dyamenahalli, U, Dai, Y, Richter, GT. Propranolol for infantile hemangiomas: early experience at a tertiary vascular anomalies center. Laryngoscope 2010;120:676–81
10Messner, AH, Perkins, JA, Messner, AH, Chang, KW. Propranolol for the treatment of airway hemangiomas: a case series and treatment algorithm. Int J Pediatr Otorhinolaryngol 2010;74:1043–8
11Haggstrom, AN, Drolet, BA, Baselga, E. Prospective study of infantile hemangiomas: clinical characteristics predicting complications and treatment. Pediatrics 2006;118:882–7
12Corbett, HJ, Mann, KS, Mitra, I, Jesudason, EC, Losty, PD, Clarke, PW. Tracheostomy – a 10-year experience from a UK pediatric surgical centre. J Pediatr Surg 2010;42:1251–4
13Cotton, RT, Tewfik, TL. Laryngeal stenosis following carbon dioxide laser in subglottic hemangioma. Report of three cases. Ann Otol Rhinol Laryngol 1985;94:494–7
14Leaute-Labreze, C, Dumas de la Roque, E, Hubiche, T, Boralevi, F, Thambo, JB, Taieb, A. Propranolol for severe hemangiomas of infancy. N Eng J Med 2008;358:2649–51
15Buckmiller, L, Dyamenahalli, U, Richter, GT. Propranolol for airway hemangiomas: case report of novel treatment. Laryngoscope 2010;119:2051–4
16Denoyelle, F, Leboulanger, N, Enjolras, O, Harris, R, Roger, G, Garabedian, EN. Role of propranolol in the therapeutic strategy of infantile laryngotracheal hemangiomas. Int J Pediatr Otorhinolaryngol 2009;73:1168–72
17Maturo, S, Hartnick, C. Initial experience using propranolol as the sole treatment for infantile airway hemangioma. Int J Pediatr Otorhinolaryngol 2010;74:323–5
18Leboulanger, N, Fayoux, P, Teissier, N, Cox, A, Van den Abeele, T, Carrabin, L et al. Propranolol in the therapeutic strategy of infantile laryngotracheal hemangioma: a preliminary retrospective study of French experience. Int J Pediatr Otorhinolaryngol 2010;74:1254–7
19Goswamy, J, Rothera, MP, Bruce, IA. Failure of propranolol in the treatment of childhood haemangiomas of the head and neck. J Laryngol Otol 2011;125:1164–72
20Siegfried, EC, Keenan, WJ, Al-Jureidini, S. More on propranolol for hemangiomas of infancy. N Eng J Med 2008;358:2846–7


Great Ormond Street Hospital treatment guidelines for use of propranolol in infantile isolated subglottic haemangioma

  • Y Bajaj (a1), K Kapoor (a1), S Ifeacho (a1), C G Jephson (a1), D M Albert (a1), J I Harper (a2) and B E Hartley (a1)...


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