Mental Health of School-Aged Children Treated with Propranolol or Atenolol for Infantile Hemangioma and Their Parents

Mireille M Hermans; Renske Schappin; Peter C J de Laat; Elodie J Mendels; Johannes M P J Breur; Hester R Langeveld; Martine F Raphael; Marlies de Graaf; Corstiaan C Breugem; Saskia N de Wildt; Jolanda M E Okkerse; Suzanne G M A Pasmans; André B Rietman

doi:10.1159/000536144

Mental Health of School-Aged Children Treated with Propranolol or Atenolol for Infantile Hemangioma and Their Parents

Dermatology. 2024;240(2):216-225. doi: 10.1159/000536144. Epub 2024 Jan 16.

Authors

Affiliations

¹ Department of Dermatology - Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, Member of the ERN-SKIN-Mosaic Group and ERN-VASCERN-VASCA Group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands, m.m.hermans@youz.nl.
² Department of Dermatology - Center of Pediatric Dermatology, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, Member of the ERN-SKIN-Mosaic Group and ERN-VASCERN-VASCA Group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.
³ Department of Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Rotterdam, The Netherlands.
⁴ Department of Pediatrics (-Hemato-oncology), Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, Member of the ERN-SKIN-Mosaic Group and ERN-VASCERN-VASCA Group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Utrecht, The Netherlands.
⁵ Department of Pediatric Cardiology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
⁶ Department of Intensive Care and Pediatric Surgery, Center of Rare Skin Diseases, Vascular Anomaly Center Erasmus MC Rotterdam, Member of the ERN-SKIN-Mosaic Group and ERN-VASCERN-VASCA Group, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.
⁷ Department of Dermatology, UMC Utrecht Center for Vascular Anomalies, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
⁸ Department Emma Children's Hospital, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
⁹ Department of Plastic Surgery, UMC Utrecht Center for Vascular Anomalies, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
¹⁰ Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands.
¹¹ Department of Pharmacology and Toxicology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
¹² Department of Child and Adolescent Psychology/Psychiatry, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Abstract

Background: Infants with infantile hemangioma (IH) have been effectively treated with propranolol or atenolol. Concerns were raised about the mental health of these children at school age, due to central nervous system effects of propranolol and visible nature of IH.

Objective: This study aimed to compare the mental health at school age of children treated with propranolol to children treated with atenolol for IHs and their parents.

Methods: This two-centered cross-sectional study included children aged ≥6 years and treated with either propranolol or atenolol for IH during infancy. Children's outcomes were performance-based affect recognition (Dutch version of the Developmental Neuropsychological Assessment-II [NEPSY-II-NL]), parent-reported emotional and behavioral functioning (Child Behavioral Checklist [CBCL]), and health-related quality of life (KIDSCREEN-27). Parents' outcome was parenting stress (Parenting Stress Questionnaire [OBVL]).

Results: Data of 105 children (36 propranolol, 69 atenolol; 6.0-11.8 years) were analyzed. Mental health outcomes did not differ between both β-blocker groups. Although overall functioning was in line with norms, children presented specific problems concerning affect recognition, parent-reported attention, and social quality of life. Parents showed increased physical symptoms, depressive symptoms, and parent-child relationship problems.

Conclusion: No difference in mental health at school age was found between children treated with propranolol or atenolol for IH. Although few overall mental health problems were found, specific problems require follow-up. Follow-up of children should be directed toward affect recognition, attention, and social functioning in daily life. Problems reported by parents could be ameliorated by mental health support during and after their infant's β-blocker treatment.

Keywords: Adrenergic beta-antagonists; Long-term adverse effects; Parenting; Psychosocial functioning; Vascular tissue neoplasms.

MeSH terms

Adrenergic beta-Antagonists / therapeutic use
Atenolol* / therapeutic use
Child
Cross-Sectional Studies
Hemangioma, Capillary* / drug therapy
Humans
Infant
Mental Health
Parents
Propranolol / therapeutic use
Quality of Life

Substances

Atenolol
Propranolol
Adrenergic beta-Antagonists

Grants and funding

This investigator-initiated study was supported by an unrestricted grant provided by Pierre Fabre Dermatologie.