Assessing the effectiveness of propranolol in treating pediatric airway hemangiomas: A systematic review and meta-analysis

Objective

Infantile hemangiomas are vascular tumors that present substantial challenges when they involve the airway. This systematic review and meta-analysis aims to explore the safety, efficacy, dosing protocols, and potential adverse effects of propranolol for management of pediatric airway hemangiomas.

Methods

Embase, PubMed, Cochrane, and Web of Science were thoroughly searched for articles from their inception up to March 2025, following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The quality of the included studies was evaluated using the Newcastle-Ottawa scale (NOS) criteria. In this review paper, successful treatment was defined as achieving full airway clearance to the extent that it no longer posed a threat to the patient's airway as assessed clinically by the treating physician.

Results

Of the 835 abstracts screened, 12 articles met inclusion criteria and encompassed 124 patients. The patients’ ages ranged from 2 months to 2.7 years (mean = 1 year). Most patients were female (n = 72, 58 %), and the mean treatment duration was 9.3 months. The pooled data indicated an overall airway clearance rate of 96.3 % (95 %CI 0.908–0.989, I2 = 0 %). Notably, the most reported method of medication delivery was 2 mg/kg/body weight/day divided into 3 oral doses. Furthermore, the pooled complication rate of 3.7 % (95 %CI: 0.010–0.092, I2 = 0 %, n = 4).

Conclusion

This meta-analysis strongly supports that propranolol provides a safe and effective approach to managing infantile hemangiomas of the airway. Propranolol can be given at 2 mg/kg/day divided in 3 doses for 6–12 months for 96 % complete clearance rate and limited rebounds after treatment cessation.