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Intravitreal bevacizumab injection for retinopathy of prematurity and pulmonary hypertension

Journal of Perinatology volume 43, pages 236–237 (2023)Cite this article

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After institutional review board approval at UC Davis Children’s Hospital, Sacramento, CA, we performed a retrospective study on preterm infants admitted in the NICU from August 2011 to July 2021, who received bevacizumab for ROP. Current procedural terminology codes (67028 intravitreal injections, J2779 and J9035 bevacizumab injections) were used to identify infants treated with bevacizumab in the NICU. Demographic data, type of ROP, echocardiographic findings within 2 weeks before and after ROP treatment, presence of bronchopulmonary dysplasia (BPD), respiratory support before and after treatment, and use of pulmonary vasodilators (inhaled nitric oxide, sildenafil, and bosentan) were collected. Echocardiographic findings including right ventricular (RV) hypertrophy, interventricular septal (IVS) flattening, elevated RV systolic pressures, and right-to-left and bidirectional shunting across the patent foramen ovale (PFO) and/or patent ductus arteriosus (PDA), were used to define PH. Finally, we also identified infants treated with laser ablation for ROP (codes 67228 and 67229) in the NICU.

A total of 15 patients received at least one dose of bevacizumab for ROP (Supplement Table 1). Eight infants (53.3%) had PH following bevacizumab therapy. Three infants had evidence of worsening PH on echocardiogram (Supplement Table 2). Five infants had new-onset PH with significant clinical deterioration and escalation of respiratory support. One infant required initiation of pulmonary vasodilator therapy (three other infants were already on pulmonary vasodilators). One of these infants required nasal continuous positive airway pressure (CPAP) for a week prior to weaning to high flow nasal cannula. Second infant required high frequency ventilation along with initiation of inhaled NO, sildenafil and bosentan. The third infant required 5 days of mechanical ventilation. In contrast, none of the infants treated with laser (n = 17) during the study period had new-onset PH, while three (17.6%) had exacerbation of PH. Seven infants (46.7%) required subsequent laser treatment following initial bevacizumab therapy.

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Fig. 1: Illustration descripting the potential mechanism by which bevacizumab may exacerbate pulmonary hypertension.

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The data presented in this study are available in this article.

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Acknowledgements

The authors would like to thank the funding sources. This work was supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) 5 R01 HD072929 09 (SL), Children’s Miracle Network Grant at UC Davis Children’s Hospital (DS).

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Authors and Affiliations

  1. Department of Pediatrics, University of California, Davis, Sacramento, CA, USA

    Lidia Park

  2. Division of Neonatology, Department of Pediatrics, University of California, Davis, Sacramento, CA, USA

    Lee Donohue, Satyan Lakshminrusimha & Deepika Sankaran

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  1. Lidia Park
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Contributions

LP drafted the initial manuscript. LP, LD, SL, and DS contributed to the concept, design, reviewed, and revised the manuscript. All the authors have critically revised and approved the final version of the manuscript. All authors agree to be accountable for all aspects of the work.

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Correspondence to Deepika Sankaran.

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Supplementary information

Supplement Table 1: Description of characteristics among infants treated with intravitreal bevacizumab for ROP.

41372_2022_1489_MOESM2_ESM.jpg

Supplement Table 2: Description of echocardiographic features, respiratory support, and pulmonary vasodilator therapy before and after intravitreal bevacizumab treatment for ROP.

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Park, L., Donohue, L., Lakshminrusimha, S. et al. Intravitreal bevacizumab injection for retinopathy of prematurity and pulmonary hypertension. J Perinatol 43, 236–237 (2023). https://doi.org/10.1038/s41372-022-01489-0

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