Effect of Intravitreal Bevacizumab on Neonates With Bronchopulmonary Dysplasia

In preterm infants with bronchopulmonary dysplasia (BPD), the use of intravitreal bevacizumab (IVB) may prolong their ventilatory support requirement, according to study findings published in the journal Chest.

Intravitreal bevacizumab is a widely used to treat retinopathy of prematurity (ROP).The researchers sought to explore whether IVB would impact respiratory outcomes among preterm infants with BPD.

The investigators conducted a single-center, retrospective cohort study of 174 very low birth weight (VLBW) preterm infants with a gestational age (GA) of less than 31 weeks and a birth body weight (BBW) of no more than 1500 g. These infants were all admitted to the neonatal intensive care unit at the National Taiwan University Hospital (NTUH) between January 2016 and June 2021. The investigators also assessed the short-term respiratory outcomes following IVB treatment in VLBW preterm infants who required ventilatory support at a postmenstrual age (PMA) of 36 weeks.  

Of the infants in the study, 71 had not been diagnosed with ROP; 69 were diagnosed with any stage of ROP except for type-1 ROP and did not receive any treatment, and 34 of the infants were diagnosed with type-1 ROP and received IVB treatment. Of the 34 infants, 2 were excluded from the IVB study group because IVB was performed after they were ventilator-free. Therefore, 32 infants with type-1 ROP received IVB treatment and were enrolled in the final analysis.

Of those infants in the ROP control group, 56 experienced ROP onset prior to being ventilator-free, whereas 46 infants experienced the most severe ROP that was diagnosed prior to being ventilator-free.

Results of the study showed that following adjustment for GA, BBW, and baseline respiratory status, IVB was significantly associated with prolonged ventilator support and a lower likelihood of being ventilator-free (hazard ratio, 0.53; P =.03).

Although PMA at onset of ROP did not differ significantly between the 2 groups (ie, ROP with IVB before ventilator-free [n=32] and ROP onset before ventilator-free [n=56]), the IVB group exhibited significantly higher PMA when ventilator-free (49.5 weeks vs 42.1 weeks, respectively; P =.001), higher PMA at discharge (51.4 weeks vs 45.1 weeks, respectively; P =.002), and longer hospitalizations (180 days vs 127.5 days, respectively; P <.001).

A major limitation of the current study is the fact that the researchers were unable to enroll patients with type-1 ROP without any treatment as the control group, because all of the infants with type-1 ROP were treated at NTUH. Thus, they were not able to discern whether a prolonged ventilator requirement was due to type-1 ROP alone or to
type-1 ROP with IVB.

The investigators concluded that future long-term follow-up for respiratory outcomes with appropriate clinical scores is warranted in this population. As with all medical therapies, “the clinician should consider the risk-benefit ratio before using IVB in neonates, especially those with BPD and refractory ROP considering multiple IVB treatments.”

Reference                                                                                                         

Huang C-Y, Huang H-C, Chen M-H, et al. Intravitreal bevacizumab is associated with prolonged ventilatory support in preterm infants with bronchopulmonary dysplasia. Chest. Published online June 23, 2022. doi:10.1016/j.chest.2022.06.017