Neurodevelopmental Outcomes Associated With Intravitreal Bevacizumab Injections for Retinopathy of Prematurity

Background: Retinopathy of prematurity (ROP) is a common disorder among premature infants associated with significant morbidity. The current standard of care includes laser ablation therapy when needed. While intravitreal bevacizumab (IVB) injections have emerged as a new therapy for ROP, so have concerns about the systemic effects of the bevacizumab (Avastin), specifically on neurodevelopmental outcomes. Purpose: To review the current literature on the impact of IVB on neurodevelopmental outcomes in neonates with ROP to inform nurses' knowledge and practice. Methods: A literature search was performed in the PubMed, CINAHL, and Embase databases. Eleven primary studies examining neurodevelopmental outcomes related to IVB were identified and reviewed. Results: Limitations of current studies, including small sample sizes, retrospective analysis subject to selection bias, and confounding factors such as sedation/anesthesia exposure, prevent robust conclusions from being drawn. However, there is not currently any clear evidence of negative neurodevelopmental impacts associated with IVB despite a sound theoretical basis for concern. Implications for Practice: Nurses should include all known and potential risks and benefits when counseling families and developing individualized plans of care for their neonatal patients with ROP. Implications for Research: Well-designed, prospective studies examining neurodevelopmental outcomes at later time points are needed to conclusively support or disprove results of IVB therapy for ROP in the context of potential adverse effects.