Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC43310.15690/vramn.v69i5-6.1048PEDIATRICS: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ ПЕДИАТРИИCLINICAL CASE OF TREATMENT OF HEPATIC HAEMANGIOMA BY PROPRANOLOL IN THE NEWBORNКЛИНИЧЕСКИЙ СЛУЧАЙ ЛЕЧЕНИЯ ПРОПРАНОЛОЛОМ ГЕМАНГИОМЫ ПЕЧЕНИ У НОВОРОЖДЕННОГОKucherovYu. I.КучеровЮ. И.
Russian Federation

PhD, professor, Head of the Department of Premature Surgery and Intensive Care of RI of Pediatric Surgery of SCCH, professor of the Department of Pediatric Surgery of N.I. Pirogov Russian National Research Medical University

доктор медицинских наук, профессор, заведующий отделением хирургии и реанимации новорожденных НИИ детской хирургии Научного центра здоровья детей, профессор кафедры детской хирургии РНИМУ им. Н.И. Пирогова

ykucherov@mail.ruZhirkovaYu. V.ЖирковаЮ. В.
Russian Federation

PhD, chief research scientist of the Department of Premature Surgery and Intensive Care of RI of Pediatric Surgery of SCCH, professor of the Department of Pediatric Anaesthesiology and Intensive Care of Faculty of advanced medical studies of N.I. Pirogov Russian National Research Medical University. Address: build. 1, 2, Lomonosovskii Avenue, Moscow, RF, 119991; tel.: +7 (499) 134-09-08

zhirkova@mail.ruGetmanA. N.ГетманА. Н.
Russian Federation

MD, Head of the Department of Computer tomography of X-ray diagnostics of Consultation-diagnostic center of SCCH. Address: build. 1, 2, Lomonosovskii Avenue, Moscow, RF, 119991; tel.: +7 (499) 134-10-65

getman@nczd.ruIvlevaS. A.ИвлеваС. А.
Russian Federation

junior research scientist of the Department of Suprasonic Diagnostics of RI of Pediatrics of SCCH. Address: build. 1, 2, Lomonosovskii Avenue, Moscow, RF, 119991; tel.: +7 (499) 162-26-01

ivlevasu@gmail.comRekhviashviliM. G.РехвиашвилиМ. Г.
Russian Federation

resident physician of SCCH. Address: build. 1, 2, Lomonosovskii Avenue, Moscow, RF, 119991; tel.: +7 (499) 134-09-08

m.rekhviashvili@bk.ruScientific Centre of Children's Health, Moscow Pirogov Russian National Research Medical University, MoscowНаучный центр здоровья детей, Москва Российский национальный исследовательский медицинский университет им. Н.И. Пирогова, МоскваN.I. Pirogov Russian National Research Medical University, Moscow, Russian FederationРоссийский национальный исследовательский медицинский университет им. Н.И. Пирогова, Москва, Российская ФедерацияScientific Centre of Children's Health, Moscow, Russian FederationНаучный центр здоровья детей, Москва, Российская Федерация01102014695-6Vestnik Rossiiskoi akademii medetsinskikh nauk / Annals of the Russian academy of medical sciencesВестник Российской академии медицинских наук818507082015Copyright ©; 1970, "Paediatrician" Publishers LLCCopyright ©; 1970, Издательство "Педиатръ"1970"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/about/submissionshttps://vestnikramn.spr-journal.ru/jour/article/view/433

Clinical observation of conservative treatment of the left hemi-liver haemangioma by propranolol in the full-term newborn with initial symptoms of cardiac failure is presented. Extensive hepatic haemangioma was diagnosed prenatally on the 23–24th week of a gestation. After the birth the clinical diagnosis was confirmed by means of ultrasound investigation (the size — 50×30 mm) and by the data of computer tomography. The starter dose of propranolol made 0.5 mg/kg per day with further increase to 1,5 mg/kg per day; the preparation was prescripted at the age of 2 days of life. Episodes of decrease in cardiac rate to 95 b/min are noted among side effects. The child was dismissed for out-patient observation at the age of 12 days of life in a stable state. The positive dynamics is registered during ultrasound investigation in 6 months after initiation of treatment: lesion was significantly decreased in the size, and there was a considerable decrease in a blood flow. Treatment by propranolol in a dose of 1,5 mg/kg per day was continued. Modern data on possible mechanisms of propranolol effect at haemangiomas in children, regimen, side effects and complications are provided in discussion. It is noted that this drug can be considered as the agent of choice in the treatment of infantile haemangiomas in children of difficult localization since the neonatality period.

Представлено клиническое наблюдение консервативного лечения пропранололом гемангиомы левой доли печени у доношенного новорожденного с начальными признаками сердечной недостаточности. Обширная гемангиома печени диагностирована внутриутробно на 23–24-й нед гестации. После рождения клинический диагноз был подтвержден при помощи ультразвукового исследования (размеры 50×30 мм) и данными компьютерной томографии. Стартовая доза пропранолола составила 0,5 мг/кг в сут с дальнейшим увеличением до 1,5 мг/кг в сут; препарат был назначен в возрасте 2 сут жизни. Из побочных эффектов отмечены эпизоды снижения частоты сердечных сокращений до 95 уд./мин. В возрасте 12 сут жизни в стабильном состоянии ребенок был выписан на амбулаторное наблюдение. Через 6 мес от начала лечения при ультразвуковом исследовании зарегистрирована положительная динамика: образование существенно уменьшилось в размерах, и произошло значительное снижение кровотока. Лечение пропранололом в дозе 1,5 мг/кг в сут было продолжено. В обсуждении приведены современные данные о возможных механизмах действия пропранолола при гемангиомах у детей, схемы его назначения, побочные эффекты и осложнения. Отмечено, что данное средство может рассматриваться как препарат выбора при лечении инфантильных гемангиом у детей сложной локализации, начиная с периода новорожденности.

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