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In preterm infants, clinicians frequently turn to topical timolol, with the presumption that topical application will result in less systemic absorption. We used Holter monitoring to assess for drug\u2010induced bradycardia in high\u2010risk infants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively reviewed the charts of 22 at\u2010risk infants who received a Holter monitor to assess for association between timolol administration and development of significant bradycardia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Four infants had episodic bradycardia detected by Holter monitoring. Two of these infants were full term; weighed more than 3,000 g; and had rare, brief, asymptomatic episodes unrelated to the timing of the timolol application. The other two infants had symptomatic bradycardia while on timolol and were the only two babies that weighed less than 2,500 g at initiation of therapy. Both were young (postmenstrual age [PMA] 34 and 37 wks) at initiation and had a timolol dose above the average exposure for the cohort.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In this cohort of at\u2010risk infants, topical timolol appeared to provide safe treatment for IHs in full\u2010term infants receiving a dose of less than 0.2 mg\/kg\/day, but infants with a PMA of less than 44 weeks and weight at treatment initiation of less than 2,500 g may be at risk of adverse events, including bradycardia, hypotension, apnea, and hypothermia. We recommend close monitoring of temperature, blood pressure, and heart rate in premature and low\u2010birthweight infants with IHs at initiation of and during therapy with topical timolol.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pde.12869","type":"journal-article","created":{"date-parts":[[2016,6,1]],"date-time":"2016-06-01T04:06:55Z","timestamp":1464754015000},"page":"405-414","source":"Crossref","is-referenced-by-count":62,"title":["Adverse Events in Young and Preterm Infants Receiving Topical Timolol for Infantile Hemangioma"],"prefix":"10.1111","volume":"33","author":[{"given":"Peter","family":"Frommelt","sequence":"first","affiliation":[{"name":"Department of Pediatrics Children's Hospital of Philadelphia Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Juern","sequence":"additional","affiliation":[{"name":"Department of Dermatology  Medical College of Wisconsin Milwaukee 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