Hemorrhagic Complications in Premature Infants Treated with Intravitreal Bevacizumab: A Comprehensive Evaluation of Risk Factors and Outcomes

This study aims to evaluate the frequency of hemorrhagic complications and identify potential risk factors in premature infants treated with intravitreal bevacizumab for retinopathy of prematurity (ROP). By addressing these gaps, we aim to enhance clinical decision-making and optimize treatment protocols in this vulnerable population. Methods: This retrospective study analyzed data from 132 premature infants treated with intravitreal bevacizumab for ROP. Hemorrhagic complications were categorized as preretinal or intravitreal based on clinical examination findings: preretinal hemorrhages were defined as bleeding confined to the ROP ridge and not exceeding two optic disc diameters, while intravitreal hemorrhages were defined as bleeding extending beyond two optic disc diameters into the vitreous cavity. Demographic and clinical variables, including gestational age, birth weight, maternal age, NICU length of stay, and the timing of anti-VEGF administration, were collected. Patients with pre-existing hemorrhages prior to treatment were excluded. Statistical analyses included descriptive methods, univariate comparisons, and binary logistic regression to identify independent risk factors for hemorrhagic complications. Results: Hemorrhagic complications were observed in 23 (17.4%) of the patients, with 91.3% being preretinal hemorrhages and 8.7% intravitreal hemorrhages. NICU length of stay was significantly longer in patients with bleeding (62.23 ± 12.87 days) compared to those without bleeding (45.78 ± 16.74 days, p < 0.0001). Logistic regression identified prolonged NICU stay as an independent risk factor for hemorrhagic complications, with each additional day increasing the risk by 5.1% (p = 0.008, OR = 1.051). Gestational age, birth weight, maternal age, and timing of anti-VEGF administration were not significantly associated with bleeding risk. Conclusions: This study highlights the significant role of NICU length of stay in increasing the risk of hemorrhagic complications in premature infants treated with intravitreal bevacizumab. The findings underscore the importance of comprehensive risk assessments, including preretinal hemorrhages, in optimizing treatment protocols. Future multicenter, prospective studies are warranted to validate these findings and refine safety strategies for ROP management.