Postnatal growth and neurodevelopment of infants treated with bevacizumab for retinopathy of prematurity

Abstract

Purpose : There continues to be uncertainty regarding the systemic effects of anti-vascular endothelial growth factor (anti-VEGF) agents in the treatment of retinopathy of prematurity (ROP). We performed a retrospective clinical study to investigate postnatal systemic outcomes in ROP infants treated with one anti-VEGF agent, intravitreal bevacizumab (IVB).

Methods : All patients who developed ROP at Ann & Robert H. Lurie Children’s Hospital of Chicago and Prentice Women’s Hospital from 2008-2019 were identified. Three study groups were formed: infants treated with IVB, infants treated with laser photocoagulation, and infants with history of ROP without treatment. Exclusion criteria included infants with nonviable course or hydrocephalus, a source of non-physiologic weight gain. Baseline characteristics, hospital course, and systemic comorbidities were recorded. Neurodevelopment was assessed with Bayley III scores, if available. Weekly weight, length, and head circumference measurements from birth through 50 weeks postmenstrual age (PMA) were compared and plotted on the Fenton preterm growth chart to examine growth trends over time.

Results : 254 infants (139 male, 115 female) were included: 22 treated with IVB, 55 treated with laser, and 177 with ROP that resolved without treatment. Plot of growth measures on the Fenton growth chart showed that the mean weight for both genders started at the 50^th percentile but deteriorated to the 14-31^st percentile in girls and the 4-12^th percentile in boys by 50 weeks PMA in all three groups. Similar trends for length and head circumference were observed in both genders, regardless of treatment status. One-way ANOVA comparing weekly changes in weight, length, and head circumference from birth to 50 weeks PMA showed no significant differences between study groups. Comparison of composite Bayley III scores at 24 months also trended to be not statistically significant.

Conclusions : There were no significant differences in postnatal systemic growth in children treated with IVB compared to those treated with laser and those not requiring treatment in this large retrospective study. These findings further demonstrate safety of bevacizumab treatment for ROP. Our observation that all three groups showed growth percentile deterioration from birth to 50 weeks PMA suggests that ROP development, regardless of treatment status, may be a negative predictor of postnatal growth.

This is a 2021 ARVO Annual Meeting abstract.