Delayed episode of necrotising enterocolitis in an ex-preterm infant after intravitreal administration of low-dose ranibizumab for the treatment of retinopathy of prematurity

BMJ Case Rep. 2024 Jun 5;17(6):e259537. doi: 10.1136/bcr-2023-259537.

Abstract

Retinopathy of prematurity (ROP) and necrotising enterocolitis (NEC) are complications of prematurity. Despite being quite different in terms of incidence, pathogenesis and consequences, both share a pathogenic role of aberrant vascularisation: increased in ROP, deficient for NEC. Current therapy for ROP includes the use of anti-vascular endothelial growth factor (anti-VEGF) agents, which are able to interrupt retinal hypervascularity. Despite being delivered intravitreously, anti-VEGF used in ROP can be absorbed into circulation and exert systemic effects. We present here a case of an ex-27 weeks gestational age infant, presenting multiple NEC risk factors, treated at 2 months of age with low-dose ranibizumab, who developed a large bowel NEC episode in the first week after treatment. We believe that this further report of an association between anti-VEGF agents and NEC could be interesting for the identification of children at risk of severe adverse events and stimulating further research on the topic.

Keywords: GI bleeding; Neonatal and paediatric intensive care; Neonatal health; Retina; Safety.

Publication types

  • Case Reports

MeSH terms

  • Angiogenesis Inhibitors* / administration & dosage
  • Angiogenesis Inhibitors* / adverse effects
  • Enterocolitis, Necrotizing* / drug therapy
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Intravitreal Injections*
  • Ranibizumab* / administration & dosage
  • Ranibizumab* / therapeutic use
  • Retinopathy of Prematurity* / drug therapy
  • Vascular Endothelial Growth Factor A / antagonists & inhibitors

Substances

  • Angiogenesis Inhibitors
  • Ranibizumab
  • Vascular Endothelial Growth Factor A