Propranolol (English name: propranolol , Chinese trade name:心得安) is a first-line drug for the treatment of hemangiomas in infants and children, and its effectiveness and safety have been proven. The drug has mild side effects and can be used safely on its own. The treatment originated from an accidental discovery by Dr. Léauté-Labrèze and other doctors at the Children’s Hospital of Bordeaux, France. The earliest report was published in the world’s authoritative medical journal “New England Journal of Medicine, NEJM” in June 2008, and was also released at the International Society for the Study of Hemangiomas and Vascular Diseases (ISSVA) Congress in Boston, which is one of the most significant discoveries in the history of hemangioma treatment. One of the most significant discoveries in the history of hemangioma treatment. Premedication physical examination: electrocardiogram (not routine), cardiac ultrasound (routine), and blood tests (not routine). Exclude arrhythmia, severe conduction block, congenital heart disease and other disorders; exclude bronchitis, pneumonia, asthma. Contraindications: Propranolol, a traditional drug that has been used for decades, is contraindicated by its specification, including cardiac pathology (conduction block), airway sensitization disorders, dyspnea, or other pulmonary disorders. Drug specification: 100 tablets/bottle, 10mg/tablet; price$2.5 to$3.5/bottle. Needs to be sealed and stored, valid for 3 years. Dosage: 1～3mg/kg, commonly used 2mg/kg, divided into 2～3 times orally, recommended to be divided into 2 times. Dosage: 10～15 minutes after breastfeeding, crush the tablet, put it in a spoon, dissolve it in 10mL of sugar water or milk water (milk powder), and pour it into the mouth at once. It should be given twice a day at intervals of 6-8 h. If the infant does not cooperate and spits out the medicine, try to make up the dose. Propranolol should be taken during the daytime after food intake, and infants <6 weeks of age should be fed at least once every 4 hours, infants 6 weeks to 4 months of age should be fed at least once every 5 hours, and infants 4 months of age should be fed at least once every 6 to 8 hours. Hypoglycemia can be avoided by taking the drug after eating. The plasma half-life after oral administration of Xanax is 3-6 h. Parents should note that complications such as diarrhea, hypotension, bradycardia, hypoglycemia, and tracheal spasm may occur after administration of the drug. If diarrhea is severe, stop taking the drug and wait for adaptation before taking it again. If tracheal or bronchial spasm or asthma is induced, the drug needs to be stopped immediately and the drug cannot be continued. Hypotension, bradycardia, hypoglycemia usually have no subjective symptoms and do not need to be treated. Other special conditions require follow-up at any time. Vaccination can be received normally during treatment. ADVERSE REACTIONS: Common adverse effects include hypoglycemia, hypotension, slowed heart rate, diarrhea, sleep alterations, and asthma attacks; others such as cold hands and feet, irritability, sweating, constipation, convulsions, lethargy, and hypothermia are rare. Usually occurring in the early stage of treatment, most of them do not require special treatment or only need symptomatic treatment, and can recover after a few days without affecting the continuation of treatment. There was no significant difference in blood glucose, liver and kidney function and thyroid function before and after treatment. Heart rate changed greatly on the first day after taking the drug, but the difference in heart rate between 3h and 6h before and after taking the drug was not statistically significant. The efficacy of propranolol on proliferative stage hemangioma in infants and children is significantly better than glucocorticoids. From the current clinical therapeutic effect, coupled with the analysis of the detailed assessment of safety and side effects established in 40 years of propranolol used in the treatment of cardiovascular diseases in infants and children, propranolol is a safer and more convenient drug for the treatment of hemangioma in infants and children. Post-treatment response: 1 week after oral administration of propranolol, the tumors began to fade in color, shrink and soften. After 3 months of treatment, most of the tumors shrink significantly. By the age of 1 year, the tumor has almost disappeared, but capillary dilatation may remain on the surface. Significant changes are seen in the first 8 weeks of treatment and at 6 months of age, with a >20% decrease in heart rate as an early indicator of efficacy. Course of treatment: The effect of propranolol on hemangiomas is most pronounced during the first week, after which improvement is slow and sometimes even periods of stagnations occur. The reason for this may be the early presumed vasoconstrictive effect, while the drug’s effect on molecular markers of hemangiomas is not clinically evident. However, drug therapy must be continued for at least 6 months, as premature discontinuation can lead to rebound. Discontinuation criteria: complete regression of the hemangioma or the end of the proliferative phase of the hemangioma at an age of more than 1 year. Discontinuation method: halve the number of times in the first 2 weeks, halve the dose in the second 2 weeks, and discontinue the drug. Observe for 1 month, if there is no rebound, complete discontinuation; if rebound, continue the drug for 1 month or longer according to the original regimen. Further studies: propranolol oral solution convenient for infants and young children, propranolol topical rub, mechanism of action of propranolol, long-term adverse effects (e.g., whether it affects intellectual development). Topical medications: propranolol powdered and mixed with Xylitol for topical application, or timolol ophthalmic solution.