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Rebound Growth of Infantile Hemangiomas After Propranolol Therapy. Pediatrics 2016 Apr;137(4) PMID: 26952504

Pubmed ID



BACKGROUND AND OBJECTIVES: Propranolol is first-line therapy for problematic infantile hemangiomas (IHs). Rebound growth after propranolol discontinuation is noted in 19% to 25% of patients. Predictive factors for rebound are not completely understood and may alter the management approach. The goal of the study was to describe a cohort of patients with IHs treated with propranolol and to identify predictors for rebound growth.

METHODS: A multicenter retrospective cohort study was conducted in patients with IHs treated with propranolol. Patient demographic characteristics, IH characteristics, and specifics of propranolol therapy were obtained. Episodes of rebound growth were recorded. Patients' responses to propranolol were evaluated through a visual analog scale.

RESULTS: A total of 997 patients were enrolled. The incidence of rebound growth was 231 of 912 patients (25.3%). Mean age at initial rebound was 17.1 months. The odds of rebound among those who discontinued therapy at <9 months was 2.4 (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.3 to 4.5; P = .004) compared with those who discontinued therapy between 12 to 15 months of life. Female gender, location on head and neck, segmental pattern, and deep or mixed skin involvement were associated with rebound on univariate analysis. With multivariate analysis, only deep IHs (OR: 3.3; 95% CI: 1.9 to 6.0; P < .001) and female gender (OR: 1.7; 95% CI: 1.1 to 2.6; P = .03) were associated. Of those with rebound growth, 83% required therapeutic modification including 62% of patients with modifications in their propranolol therapy.

CONCLUSIONS: Rebound growth occurred in 25% of patients, requiring modification of systemic therapy in 15%. Predictive factors for rebound growth included age of discontinuation, deep IH component, and female gender. Patients with these predictive factors may require a prolonged course of therapy.

Author List

Shah SD, Baselga E, McCuaig C, Pope E, Coulie J, Boon LM, Garzon MC, Haggstrom AN, Adams D, Drolet BA, Newell BD, Powell J, GarcĂ­a-Romero MT, Chute C, Roe E, Siegel DH, Grimes B, Frieden IJ


Beth A. Drolet MD Professor in the Dermatology department at Medical College of Wisconsin
Dawn Siegel MD Associate Professor in the Dermatology department at Medical College of Wisconsin


2-s2.0-84962623962   24 Citations

MESH terms used to index this publication - Major topics in bold

Adrenergic beta-Antagonists
Cohort Studies
Drug Administration Schedule
Infant, Newborn
Retrospective Studies
jenkins-FCD Prod-296 4db9d02597e0a2e889e230f853b641c12f1c3ee3