ABSTRACT Background Propranolol is widely adopted as the first‐line treatment for problematic infantile hemangioma (IH). Despite its efficacy and widespread use, concerns persist about potential long‐term neurodevelopmental risks, given propranolol′s ability to cross the blood‐brain barrier during early development. Objectives To evaluate the long‐term risk of neurodevelopmental disorders among patients with IH treated with propranolol compared to those not receiving systemic therapies, and to assess whether delayed initiation of propranolol affects these risks. Methods We conducted a population‐based, retrospective cohort study using the TriNetX platform. Children with IH diagnosed before age three were grouped based on treatment exposure: propranolol‐treated versus untreated (no systemic therapy). Propensity score matching was performed (1:1) for demographics and comorbidities. The primary outcomes included six neurodevelopmental diagnoses: attention‐deficit/hyperactivity disorder (ADHD), behavioural and emotional disorders (BED), speech and language development disorders (SLDD), scholastic skill disturbances (SSD), learning disorders (LD), and autism spectrum disorder (ASD). A subanalysis examined delayed initiation of propranolol (3–12 months and 1–2 years after diagnosis). Results Among 10,143 matched pairs, propranolol use was not associated with increased risk of ADHD, SSD or ASD. Conversely, propranolol was associated with significantly reduced risks of BED (HR, 0.77; 95% CI, 0.68–0.88), SLDD (HR, 0.77; 95% CI, 0.70–0.85), and LD (HR, 0.78; 95% CI, 0.66–0.93). No increased risk was observed in the delayed‐treatment subgroup. Conclusions Propranolol treatment for IH was not associated with elevated neurodevelopmental risk and may be linked to a lower incidence of several developmental disorders. These findings support the long‐term neurodevelopmental safety of propranolol.
Kridin et al. (Fri,) studied this question.