Propranolol (English name: propranolol , Chinese trade name: 心得安) is a classic old drug for the treatment of heart disease, especially coronary heart disease, its inventor, the British scientist Sir James W. Black is with it and won the 1988 Nobel Prize in physiology or medicine. Since 2008, the American “New England Medicine” magazine introduced the success of the treatment of hemangioma, the success of the treatment of hemangioma for infants and children to provide a new approach to the effective treatment of hemangioma, its efficacy, adverse reactions are small, to the majority of children with hemangioma brought the gospel, but also for the basic research of hemangioma provides a new idea. The first report was published in June 2008 in the New England Journal of Medicine (NEJM), the world’s leading medical journal, and was also presented at the International Society for the Study of Vascular and Angiomatous Diseases (ISSVA) Congress in Boston, making it one of the most significant discoveries in the history of hemangioma treatment. It is one of the most significant discoveries in the history of hemangioma treatment. Pre-medication physical examination: ECG (not routine), cardiac ultrasound (routine), 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 indicated for contraindications including cardiac disease (conduction block), airway sensitivity disorders, ventilation difficulties, or other pulmonary diseases. Drug specifications: 100 tablets/bottle, 10mg/tablet; price 2.5 to 3.5 yuan/bottle. Need to be sealed and stored, valid for 3 years. Dosage: 1~3mg/kg, commonly 1 or 2mg/kg, divided into 2~3 oral doses, recommended to be divided into 2 doses. Dosage: 10-15 minutes after breastfeeding, crush the tablet, put it in a spoon, dissolve it in 10mL of sugar or milk water (milk powder) and pour it into the mouth at once. If the infant does not cooperate in spitting out the medicine, try to take a refill according to the amount. Propranolol should be given during the day after eating, at least once in 4 hours for infants <6 weeks, once in 5 hours for infants 6 weeks to 4 months, and once in 6-8 hours for infants 4 months old. The drug can be taken after eating to avoid hypoglycemia. The plasma half-life (plasma half-life) is 3-6 h after oral administration. Note to parents: Diarrhea, hypotension, bradycardia, hypoglycemia, tracheospasm and other complications may occur after taking the drug. If diarrhea is severe, the drug should be stopped and taken again after the symptoms have completely disappeared and adapted. If tracheal or bronchospasm or asthma is induced, the drug needs to be discontinued immediately, and the drug cannot be continued. Hypotension, bradycardia and hypoglycemia usually have no subjective symptoms and do not need to be treated. During the treatment period, vaccinations can be received normally. In case of high fever and cough due to cold, the medication needs to be temporarily discontinued and continued after the cold has recovered. In other special cases, a follow-up visit is required at any time. Adverse effects: Common adverse effects include hypoglycemia, hypotension, slowed heart rate, diarrhea, sleep changes, and asthma attacks; others such as chills in the hands and feet, irritability, sweating, constipation, convulsions, lethargy, and hypothermia are rare. They usually occur at the beginning of treatment and most of them do not require special treatment or only 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. The efficacy of propranolol on proliferative hemangiomas in infants and children is significantly better than that of glucocorticoids. From the current clinical treatment results, together with the detailed evaluation of safety and side effects established over 40 years of propranolol use in the treatment of cardiovascular diseases in infants and children, propranolol is a safer and more convenient drug for the treatment of hemangiomas in infants and children. Post-treatment response: 1 week after oral administration of propranolol, the tumors began to lighten in color and shrink and soften. After 3 months of treatment, most of the tumors shrank significantly. By the age of 1 year, the tumor is largely regressed, but capillary dilatation may remain on the surface. Significant changes are seen in the first 8 weeks and at 6 months of age, with a >20% decrease in heart rate being an early indicator of onset of action. The effects of propranolol on angiodysplasia are most pronounced during the first week, followed by a slow rate of improvement and sometimes a period of stagnations. The reason for this may be the early presumed vasoconstrictive effect, while the effect of the drug on molecular markers of hemangioma 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 age over 1 year and end of the proliferative phase of the hemangioma. Discontinuation method: Halve the number of doses in the first 2 weeks and halve the dose in the second 2 weeks and discontinue the drug. Observe for 1 month, if no rebound, complete discontinuation; if rebound, continue the drug for 1 month or longer according to the original regimen. Disadvantages: Propranolol is a non-selective beta-blocker with no intrinsic activity, and is not highly bioavailable after oral administration due to the first-pass effect, with only about 25% entering the circulation. Further studies: Propranolol oral solution convenient for infants and children, propranolol topical rub, mechanism of action of propranolol, long-term adverse effects (e.g., whether it affects mental development), etc. Christine, the discoverer of the propranolol treatment modality, worked with the drug company to develop an oral propranolol dosage form suitable for children with IH aged 1 to 5 months and reported the results of a multicenter randomized double-blind study of 460 cases, confirming that the newly developed dosage form is safe and effective and fully meets clinical needs. Studies by scholars in the United States have confirmed that propranolol does not affect the growth and development of children with IH, nor does it affect the secretion of growth hormone in children with IH. In terms of psychology, studies by scholars have confirmed that oral propranolol does not affect the psychological development of children with IH. The safety of propranolol has been widely recognized by scholars from various countries. However, the problem of recrudescence in the treatment of IH with propranolol cannot be ignored. In a multicenter retrospective study of 997 children in the United States, Dr. Shah et al. showed that the recurrence rate after discontinuation of oral propranolol was as high as 25.4%, and that segmental, deep-seated, and cephalic lesions were factors that predisposed to recurrence after discontinuation of the drug.