BACKGROUND: Intravitreal bevacizumab (IVB), an anti-vascular endothelial growth factor (anti-VEGF) antibody, is a widely adopted treatment for retinopathy of prematurity (ROP). Although animal studies have demonstrated that IVB inhibits alveologenesis in neonatal rat lung, the clinical influence of IVB on respiratory outcomes has never been studied. RESEARCH QUESTION: Would intravitreal bevacizumab affect the respiratory outcome in preterm infants with bronchopulmonary dysplasia? STUDY DESIGN AND METHODS: We retrospectively assessed very low birth weight (VLBW) preterm infants admitted to our neonatal intensive care unit between January 2016 and June 2021. Furthermore, we evaluated the short-term respiratory outcomes after IVB therapy in VLBW preterm infants requiring ventilatory support at a postmenstrual age (PMA) of 36 weeks. RESULTS: One hundred and seventy-four VLBW preterm infants with bronchopulmonary dysplasia were recruited. There were 88 infants with ROP onset before ventilator-free and 78 infants with the most severe ROP diagnosed before ventilator-free. Among them, 32 were diagnosed with type-1 ROP and received IVB treatment. After adjusting for gestational age, birth bodyweight, and baseline respiratory status, we discovered that IVB is significantly associated with prolonged ventilatory support and a lower likelihood of ventilator-free (HR = 0.53, P = 0.03). INTERPRETATION: IVB may have a short-term respiratory adverse effect in patients requiring ventilatory support at PMA of 36 weeks. Therefore, long-term follow up for respiratory outcomes may be considered in VLBW infants with IVB treatment.
