Color Doppler Ultrasound Indices Can Predict Propranolol Response in Infantile Hemangioma

A new study assessed the effectiveness of color Doppler ultrasonography in evaluating the response of infantile hemangioma to oral propranolol treatment. 

This prospective study was conducted between 2016 and 2022 and involved children with symptomatic infantile hemangioma – who received outpatient therapy with oral propranolol at a dose of 2 mg/kg per day in three divided doses. Response to treatment was evaluated three months after starting treatment (intermediate clinical response) and three months after completing treatment (final clinical response, FCR). The primary outcome measures included clinical and radiological responses (assessed through resistivity index (RI), pulsatility index (PI), and peak systolic velocity). Secondary outcomes included treatment-related complications. 

Out of 601 patients initially treated with propranolol, 99 were excluded due to severe adverse effects. Among the remaining 502 participants, 64.3% showed an excellent response at FCR; 17.7% showed partial response; and 17.9% were non-responders. Doppler USG indices, particularly RI and PI, exhibited predictive value in identifying responders at three months, with increases greater than certain thresholds correlating with excellent response. 

The results underscore the utility of color Doppler ultrasonography in guiding treatment decisions for infantile hemangioma, potentially preventing unnecessary exposure to propranolol in non-responders and facilitating timely consideration of alternative therapies. Doppler USG indices – RI and PI, can predict the response to propranolol in children with infantile hemangioma at three months. This insight could potentially prevent unnecessary exposure to propranolol in non-responding patients and allowing for a timely shift toward alternative therapies.

Source: Pandey V, Bera RN, Diwedi AN, Singh OP, Tiwari P. Indian Pediatrics. 2024 Mar 1;61(3):237-42.