Subglottic hemangioma—prevalence, clinical presentation and treatment
1Department of Pulmonology, Mother and Child Health Care Institute of Serbia, 11000 Belgrade, Serbia
2School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
DOI: 10.22514/sv.2023.095 Vol.19,Issue 6,November 2023 pp.38-42
Submitted: 05 November 2022 Accepted: 13 February 2023
Published: 08 November 2023
This retrospective study aimed to investigate the clinical features and treatment of pediatric subglottic hemangioma (SH), identify risk factors for treatment-induced adverse effects, and identify a strategy for timely therapy discontinuation in children diagnosed with SH at the national pediatric center. Medical records of patients presented with stridor from 2010 to 2020 were retrieved and assessed, the diagnosis of SH was established via flexible bronchoscopy, and the patients were treated using propranolol with a subsequent gradual dose increase to 3 mg/kg body weight daily. A two-week oral steroids trial was added for those with circumferential lesions. Early indicators of a good therapeutic response included decreased stridor and primary lesion size on follow-up bronchoscopy performed one week after propranolol commencement. Duration of therapy, tailored individually based on bronchoscopy findings, and at least twelve months of treatment were the two main criteria for deciding therapy termination. Outpatient visits were arranged at least every three months. Our results showed that SH was the third most frequent cause of stridor (15/137 patients), and biphasic stridor was uniformly present as a typical symptom. Both clinical improvement and bronchoscopy findings confirmed the efficacy of the treatment. The mean therapy duration was 17 months. The only significant adverse event observed was hypoglycemic seizures in one infant. Contributory factors were all prematurity, high propranolol dose (3 mg/kg) and poor oral intake. Collectively, defining a safe and timely protocol for therapy cessation and avoidance of risk factors for adverse effects is the mainstay of SH treatment.
Subglottic hemangioma; Propranolol; Hypoglycemic seizures
Mihail Basa,Predrag Minic,Bojana Gojsina,Aleksandar Sovtic. Subglottic hemangioma—prevalence, clinical presentation and treatment. Signa Vitae. 2023. 19(6);38-42.
 Hull J, Forton J, Thomson A. Stridor. Paediatric Respiratory Medicine (pp. 31–38). 2nd edition. Oxford University Press: Oxford. 2015.
 Hoeger PH, Harper JI, Baselga E, Bonnet D, Boon LM, Atti MCD, et al. Treatment of infantile haemangiomas: recommendations of a European expert group. European Journal of Pediatrics. 2015; 174: 855–865.
 Krowchuk DP, Frieden IJ, Mancini AJ, Darrow DH, Blei F, Greene AK, et al. Clinical practice guideline for the management of infantile hemangiomas. Pediatrics. 2019; 143: e20183475.
 Chang LC, Haggstrom AN, Drolet BA, Baselga E, Chamlin SL, Garzon MC, et al. Growth characteristics of infantile hemangiomas: implications for management. Pediatrics. 2008; 122: 360–367.
 Bauland CG, Lüning TH, Smit JM, Zeebregts CJ, Spauwen PHM. Untreated hemangiomas: growth pattern and residual lesions. Plastic and Reconstructive Surgery. 2011; 127: 1643–1648.
 Léauté-Labréze C, Hoeger P, Mazereeuw-Hautier J. A randomized controlled trial of oral propranolol in infantile hemangioma. Journal of Vascular Surgery. 2015; 62: 518–519.
 Holland KE, Drolet BA. Approach to the patient with an infantile hemangioma. Dermatologic Clinics. 2013; 31: 289–301.
 Holland KE, Frieden IJ, Frommelt PC, Mancini AJ, Wyatt D, Drolet BA. Hypoglycemia in children taking propranolol for the treatment of infantile hemangioma. Archives of Dermatology. 2010; 146: 775–778.
 Sovtic A, Grba T, Grahovac D, Minic P. Flexible bronchoscopy in evaluation of persistent wheezing in children-experiences from national pediatric center. Medicina. 2020; 56: E329.
 Ji Y, Chen S, Xu C, Li L, Xiang B. The use of propranolol in the treatment of infantile haemangiomas: an update on potential mechanisms of action. British Journal of Dermatology. 2015; 172: 24–32.
 Hermans DJJ, Bauland CG, Zweegers J, van Beynum IM, van der Vleuten CJM. Propranolol in a case series of 174 patients with complicated infantile haemangioma: indications, safety and future directions. British Journal of Dermatology. 2013; 168: 837–843.
 Hardison S, Wan W, Dodson KM. The use of propranolol in the treatment of subglottic hemangiomas: a literature review and meta-analysis. International Journal of Pediatric Otorhinolaryngology. 2016; 90: 175–180.
 Shah SD, Baselga E, McCuaig C, Pope E, Coulie J, Boon LM, et al. Rebound growth of infantile hemangiomas after propranolol therapy. Pediatrics. 2016; 137: e20151754.
 Wu L, Wu X, Xu X, Chen Z. Propranolol treatment of subglottic hemangiomas: a review of the literature. International Journal of Clinical and Experimental Medicine. 2015; 8: 19886–19890.
 Bajaj Y, Kapoor K, Ifeacho S, Jephson CG, Albert DM, Harper JI, et al. Great Ormond Street Hospital treatment guidelines for use of propranolol in infantile isolated subglottic haemangioma. The Journal of Laryngology & Otology. 2013; 127: 295–298.
 Léaute-Labrèze C, Boccara O, Degrugillier-Chopinet C, Mazereeuw-Hautier J, Prey S, Lebbé G, et al. Safety of oral propranolol for the treatment of infantile hemangioma: a systematic review. Pediatrics. 2016; 138: e20160353.
 Drolet BA, Frommelt PC, Chamlin SL, Haggstrom A, Bauman NM, Chiu YE, et al. Initiation and use of propranolol for infantile hemangioma: report of a consensus conference. Pediatrics. 2013; 131: 128–140.
 van Veen MR, van Hasselt PM, de Sain-van der Velden MGM, Verhoeven N, Hofstede FC, de Koning TJ, et al. Metabolic profiles in children during fasting. Pediatrics. 2011; 127: e1021–e1027.
 Ji Y, Chen S, Wang Q, Xiang B, Xu Z, Zhong L, et al. Intolerable side effects during propranolol therapy for infantile hemangioma: frequency, risk factors and management. Scientific Reports. 2018; 8: 4264.
 Ji Y, Wang Q, Chen S, Xiang B, Xu Z, Li Y, et al. Oral atenolol therapy for proliferating infantile hemangioma. Medicine. 2016; 95: e3908.
Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.
Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.
Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.
Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.
Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.
Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.
Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.