Dual Therapy with Beta Blockers and Sirolimus in a Case of Life-threatening Diffuse Neonatal Hemangiomatosis

Infantile hemangiomas are common, but diffuse neonatal hemangiomatosis is rare. The first-line treatment for infantile hemangiomas is enteral propranolol. However, optimal treatment for diffuse neonatal hemangiomatosis remains unknown. We describe the case of a now 24-month-old child with diffuse, innumerable cutaneous and hepatic infantile hemangiomas who was treated with beta blockers and sirolimus therapy in the setting of congestive heart failure and pulmonary hypertension as a neonate. The purpose of this paper is to demonstrate our experience with the use of sirolimus in combination with beta blockers for life-threatening diffuse hemangiomatosis. It highlights the role of intravenous beta blockers when oral propranolol could not be used due to clinical complications.