A Meta-Analysis of Neurodevelopmental Outcomes following Intravitreal Bevacizumab for the Treatment of Retinopathy of Prematurity.

IF 2.6 3区医学 Q1 PEDIATRICS

Neonatology Pub Date : 2023-01-01 Epub Date: 2023-07-24 DOI:10.1159/000531541

Abed A Baiad, Imaan Z Kherani, Marko M Popovic, Glen Katsnelson, Rajeev H Muni, Kamiar Mireskandari, Nasrin N Tehrani, Tianwei Ellen Zhou, Peter J Kertes

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引用次数: 0

Abstract

Background: Retinopathy of prematurity (ROP) is the most common cause of preventable blindness in preterm infants. First-line treatments include intravitreal bevacizumab (IVB) or laser photocoagulation (LPC).

Objectives: The aim of the study was to evaluate neurodevelopmental safety of IVB compared to LPC for ROP.

Methods: MEDLINE, Embase, and Cochrane library were searched up to September 2022. Studies were included with at least 12-month follow-up of primary outcomes such as severe neurodevelopmental impairment (sNDI), cerebral palsy (CP), and hearing impairment (HI). Secondary outcomes were moderate-to-severe neurodevelopmental impairment (msNDI), Bayley Scores of Infant Development (BSID-III), and visual impairment.

Results: 1,231 patients from 11 comparative studies were included. Quality of evidence was rated low for all outcomes. IVB was associated with a higher risk for sNDI (risk ratio [RR] = 1.25, 95% confidence interval [CI]: [1.01, 1.53], p = 0.04); and CP (RR = 1.40, CI: [1.08, 1.81], p = 0.01) compared to LPC. There was no significant difference between IVB and LPC for msNDI (RR = 1.15, CI: [0.98, 1.35], p = 0.08) and HI (RR = 1.43, CI: [0.86, 2.39], p = 0.17). BSID-III percentile scores were similar between IVB and LPC, with weighted mean differences of 1.51 [CI = -1.25, 4.27], 2.43 [CI = -1.36, 6.22], and 1.97 [CI = -1.06, 5.01] for cognitive, language, and motor domains, respectively (p > 0.05).

Conclusion: To our knowledge, this is the largest meta-analysis on neurodevelopmental outcomes and the first to rigorously examine IVB monotherapy in ROP treatment. Compared to LPC, there was a marginally increased risk for sNDI and CP with IVB but little or no difference in the risk of msNDI and HI. Further randomized studies are needed to strengthen these findings.

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贝伐单抗治疗早产视网膜病变后神经发育结果的荟萃分析。

背景：早产儿视网膜病变（ROP）是早产儿可预防失明的最常见原因。一线治疗包括玻璃体内贝伐单抗（IVB）或激光光凝（LPC）。目的：本研究的目的是评估IVB与LPC治疗ROP的神经发育安全性。方法：检索截至2022年9月的MEDLINE、Embase和Cochrane文库。研究包括对主要结果进行至少12个月的随访，如严重神经发育障碍（sNDI）、脑瘫（CP）和听力障碍（HI）。次要结果为中度至重度神经发育障碍（msNDI）、婴儿发育Bayley评分（BSID-III）和视觉障碍。结果：纳入了来自11项比较研究的1231名患者。所有结果的证据质量都很低。IVB与sNDI的高风险相关（风险比[RR]=1.25，95%置信区间[CI]:[1.01，1.53]，p=0.04）；CP（RR=1.40，CI:[1.08，1.81]，p=0.01）。对于msNDI（RR=1.15，CI:[0.98，1.35]，p=0.08）和HI（RR=1.43，CI:[886，2.39]，p=0.17），IVB和LPC之间没有显著差异。IVB和LPC之间的BSID-III百分位得分相似，认知、语言和运动领域的加权平均差异为1.51[CI=1.25，4.27]，2.43[CI=1.36，6.22]和1.97[CI=1.06，5.01]，结论：据我们所知，这是关于神经发育结果的最大的荟萃分析，也是第一个严格检查IVB单药治疗ROP的荟萃分析。与LPC相比，sNDI和CP与IVB的风险略有增加，但msNDI和HI的风险几乎没有差异。需要进一步的随机研究来加强这些发现。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neonatology 医学-小儿科

CiteScore

0.60

自引率

4.00%

发文量

审稿时长

6-12 weeks

期刊介绍： This highly respected and frequently cited journal is a prime source of information in the area of fetal and neonatal research. Original papers present research on all aspects of neonatology, fetal medicine and developmental biology. These papers encompass both basic science and clinical research including randomized trials, observational studies and epidemiology. Basic science research covers molecular biology, molecular genetics, physiology, biochemistry and pharmacology in fetal and neonatal life. In addition to the classic features the journal accepts papers for the sections Research Briefings and Sources of Neonatal Medicine (historical pieces). Papers reporting results of animal studies should be based upon hypotheses that relate to developmental processes or disorders in the human fetus or neonate.