Hemorrhagic complications in premature infants treated with intravitreal bevacizumab

This study aims to evaluate the frequency of hemorrhagic complications and identify potential risk factors in premature infants treated with intravitreal bevacizumab for retinopathy of prematurity (ROP).

This retrospective study analyzed data from 132 premature infants treated with intravitreal bevacizumab for ROP. Hemorrhagic complications were categorized as preretinal or intravitreal based on clinical examination findings: preretinal hemorrhages were defined as bleeding confined to the ROP ridge and not exceeding two optic disc diameters, while intravitreal hemorrhages were defined as bleeding extending beyond two optic disc diameters into the vitreous cavity. Demographic and clinical variables, including gestational age, birth weight, maternal age, NICU length of stay, and the timing of anti-VEGF administration, were collected. Patients with pre-existing hemorrhages prior to treatment were excluded. Statistical analyses included descriptive methods, univariate comparisons, and binary logistic regression to identify independent risk factors for hemorrhagic complications.

Hemorrhagic complications were observed in 23 (17.4%) of the patients, with 91.3% being preretinal hemorrhages and 8.7% intravitreal hemorrhages. NICU length of stay was significantly longer in patients with bleeding (62.23 ± 12.87 days) compared to those without bleeding (45.78 ± 16.74 days, p < 0.0001). Logistic regression identified prolonged NICU stay as an independent risk factor for hemorrhagic complications, with each additional day increasing the risk by 5.1% (p = 0.008, OR = 1.051, 95% CI 1.013-1.091). Gestational age, birth weight, maternal age, and timing of anti-VEGF administration were not significantly associated with bleeding risk.

This study highlights the significant role of NICU length of stay in increasing the risk of hemorrhagic complications in premature infants treated with intravitreal bevacizumab. In retinopathy. of prematurity treated with bevacizumab, preretinal and vitreous hemorrhages are common. Each additional day of NICU stay increases the risk of hemorrhagic complications.