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Bevacizumab for Retinopathy of Prematurity: 2-Year Neurodevelopmental Follow-up
Michael Zayek1, Kaitlyn Parker1, Monika Rydzewska2
1Division of Neonatology, Department of Pediatrics, University of South Alabama, Mobile, Alabama.
Insights
Intravitreal bevacizumab (IVB) for retinopathy of prematurity (ROP) did not increase death or neurodevelopmental impairment in extremely preterm infants. This treatment appears safe for periviable infants, showing no increased mortality or adverse outcomes.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Developmental Pediatrics
Background:
- Retinopathy of prematurity (ROP) is a significant cause of visual impairment in preterm infants.
- Intravitreal bevacizumab (IVB) has emerged as an alternative treatment for ROP, but its long-term safety regarding survival and neurodevelopmental outcomes requires further investigation.
Purpose of the Study:
- To compare the risk of death or neurodevelopmental impairment (NDI) in extremely preterm infants treated with intravitreal bevacizumab (IVB) for ROP versus those treated with laser therapy only.
- To assess the safety and efficacy of IVB in periviable preterm infants.
Main Methods:
- A retrospective study of 146 infants born before 27 weeks gestation with birth weight under 1,000g requiring ROP therapy.
- Infants were divided into two groups: those treated with IVB (n=61) and those treated with laser only (n=85).
- Death and NDI rates were evaluated at 18 to 24 months corrected age.
Main Results:
- The rates of death or severe NDI were 62% in the IVB group and 53% in the laser-only group, a difference that was not statistically significant.
- Despite a sample selection bias favoring growth-restricted infants for IVB treatment (median BW 481g vs. 547g, p=0.003), the adjusted odds ratio for death or severe NDI was 0.86 (95% CI: 0.33-2.20).
Conclusions:
- Intravitreal bevacizumab therapy for retinopathy of prematurity did not significantly affect survival or neurodevelopmental outcomes in extremely preterm infants.
- The findings suggest that IVB therapy may be a safe option for periviable preterm infants, without increasing mortality or adverse neurodevelopmental outcomes.
Objective:
This study aimed to determine whether infants who were treated with intravitreal bevacizumab (IVB) for retinopathy of prematurity (ROP) were at higher risk of death or neurodevelopmental impairment (NDI) when compared with infants who were not treated with IVB (Laser only).
Study Design:
This retrospective study included 146 infants born from 2009 through 2016 with a birth weight (BW) <1,000 g, gestational age <27 weeks, and required ROP therapy. Death and NDI rates were assessed at 18 to 24 months' corrected age.
Results:
Rates of death or severe NDI were 62 and 53% in the IVB (n = 61) and Laser only (n = 85) groups, respectively. This difference was not statistically different despite sample selection bias in treating growth-restricted infants with IVB, BW (median [IQR]) was 481 (420-583) versus 547 (473-640) g in IVB and Laser only groups, respectively, p = 0.003. The adjusted odds ratio and 95% confidence interval of death or severe NDI was 0.86 (0.33-2.20).
Conclusion:
Bevacizumab therapy for ROP did not affect survival and neurodevelopment of extremely preterm infants.
Key Points:
· Intravitreal bevacizumab therapy for retinopathy of prematurity may be safe in periviable preterm infants.. · Intravitreal bevacizumab therapy does not increase mortality rate in periviable preterm infants.. · Intravitreal bevacizumab therapy does not increase adverse neurodevelopmental outcome in periviable infants..
