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