Neurodevelopmental outcomes of preterm infants treated with bevacizumab for severe retinopathy of prematurity

Abstract

 

Purpose

 

Intravitreal injection of bevacizumab, a vascular endothelial growth factor inhibitor (VEGF), is used to treat retinopathy of prematurity (ROP). As bevacizumab can diffuse into the systemic circulation, potential long-term effect on brain development needs to be documented. The purpose of this study is to compare neurodevelopmental outcomes at 18-22 months of preterm infants treated with bevacizumab vs. laser.

 

Methods

 

Data from the Canadian Neonatal Network and the Canadian Neonatal Follow-Up Network databases were retrospectively reviewed. A total of 114 infants born < 29 weeks GA in 2010-2011 with severe ROP (≥ stage 3 or plus disease) requiring treatment and followed at 18-22 months corrected age were studied. Neurodevelopmental outcome was assessed using the Bayley Scales 3^rd edition (BSID-III), reporting scores out of a 100 for 3 categories: cognition, language and motor. Regression analyses were performed.

 

Results

 

Of the 114 infants, 32 were injected with bevacizumab (GA 24.8±1.5 weeks, birth weight 740±160g) and 82 had laser therapy (GA 24.8±1.3 weeks, birth weight 711±132g). Neonatal characteristics differed between the bevacizumab vs. laser therapy groups for male sex (62% vs. 42%), SNAP-II score (24 vs. 18), and late onset sepsis (62% vs. 44%). Bevacizumab treated infants had lower motor scores after adjustment for potential confounders. The injected group had a mean difference (95% CI) of -12.0 (-20.0, -3.9) points at th BSID-III and a mean odds ratio of 3.31 (1.10, 9.96) of presenting a motor delay (composite score < 85) compared to the laser treated infants (table 1).

 

Conclusions

 

Preterm infants treated with bevacizumab had lower motor scores compared to those treated with laser therapy. There was no difference in cognition and language scores. Further investigation on the long-term safety of anti-VEGF treatment for ROP is needed.  

 

Table 1: Comparison of developmental outcomes of infants treated with bevacizumab vs laser (baseline group: laser), after adjustment for gestational age, sex, antenatal steroids, multiple birth, bronchopulmonary dysplasia, late onset sepsis, brain injury (intraventricular hemorrhage, periventricular leukomalacia) and maternal education.