Oral Propranolol Before 45 Weeks’ Corrected Gestational Age for Complicated Infantile Hemangiomas: A Retrospective Single-Center Study

Background: Oral propranolol (OP) is the first-line treatment for complicated and high-risk infantile hemangiomas (IH). However, the optimal timing of treatment initiation in preterm infants remains uncertain, as current recommendations generally discourage administration before 45 weeks of corrected gestational age (CGA). We aimed to evaluate the safety and feasibility of early OP administration in selected preterm infants or term newborn with complicated high-risk IH. Methods: We retrospectively reviewed patients treated with OP for IH at a tertiary referral center between January 2023 and April 2026. Patients were divided according to CGA at treatment initiation into an early-treatment group (<45 weeks CGA) and a standard-timing group (≥45 weeks CGA). Clinical characteristics, treatment modalities, and adverse events were collected and compared between groups. Results: Seventy-five patients were included: 9 received early OP (mean CGA at treatment initiation 38 weeks + 3 days) and 66 that started treatment at or after 45 weeks CGA. Early-treated infants showed a higher prevalence of complicated IH at diagnosis (88.9% vs. 4.5%). No major adverse events, including clinically significant bradycardia, hypotension, arrhythmias, respiratory complications, or treatment discontinuation, occurred in either group. Transient asymptomatic hypoglycemia occurred in five patients, all belonging to the standard-timing group, and resolved with feeding. Treatment duration was comparable between groups. Conclusions: Early OP administration before 45 weeks CGA may represent a feasible and well-tolerated option in selected preterm infants and term newborn with complicated high-risk IH when initiated in a protected neonatal setting with careful monitoring. These findings may suggest individualized risk-based decision-making in selected cases, rather than routine treatment before current age thresholds.