Infantile Hemangioma Treated with Propranolol: Learning from an Infant Death

Infantile hemangioma (sometimes called a “strawberry birthmark”) is a benign vascular, soft-tissue tumour that affects 4% to 10% of infants.1-4 Most infantile hemangiomas resolve spontaneously, without treatment, but some may warrant medical or surgical treatment because of interference with function, significant disfigurement, or, in rare cases, life-threatening physiologic compromise.4,5 As part of an ongoing collaboration with a provincial death investigation service, ISMP Canada received a report of the death of an infant who was receiving propranolol for the treatment of infantile hemangioma (an off-label indication for this drug). Although ISMP Canada’s review of the use of propranolol in this case found no evidence of a medication error, several learning opportunities were identified and are shared here.