Retinopathy of prematurity is a disease of the developing retina driven largely by abnormal vascular growth after premature birth, and its global burden has been rising as survival of extremely preterm infants improves. Anti-vascular endothelial growth factor agents such as ranibizumab have become an increasingly important treatment option, offering a faster alternative to laser photocoagulation in many cases. The RAINBOW randomized trial and its five-year follow-up demonstrated that ranibizumab could match laser therapy in very low birthweight infants, and network meta-analyses comparing aflibercept, bevacizumab, conbercept and ranibizumab have reinforced the role of intravitreal injections in modern practice. Yet the injection itself is a surgical procedure: it requires general anesthesia in an infant who may weigh barely a kilogram, whose respiratory drive is unstable, and whose airway anatomy makes standard adult techniques hazardous.

The vulnerability of preterm infants under anesthesia is well documented. Their chest walls are compliant, their diaphragms fatigue easily, and their brains exert immature control over breathing patterns. Apnea, bradycardia and desaturation are recognized hazards of general anesthesia in this population, and the risk of postoperative respiratory failure is a central concern in any procedure requiring sedation. Previous work has shown that prematurity is a critical risk factor for respiratory failure after even brief operations such as inguinal hernia repair, and international registries of neonatal intubation reveal that a substantial fraction of attempts are associated with adverse events, particularly when multiple attempts are needed. Against this backdrop, the choice between a supraglottic device that sits above the vocal cords and an endotracheal tube that passes through them carries real physiological weight.

The Beijing team examined 134 preterm infants who received intravitreal ranibizumab under general anesthesia in the operating room. Of these, 83 were managed with a laryngeal mask airway, a device that seals over the laryngeal inlet without entering the trachea, while 51 underwent endotracheal intubation. The primary outcome was escalation of respiratory support within 24 hours after the procedure, a clinically meaningful measure of how hard the infant’s respiratory system had to work to recover. Because this was not a randomized trial, the researchers recognized that infants receiving each airway device might differ systematically in weight, gestational age, baseline oxygen needs and comorbidities. To address this, they applied inverse probability of treatment weighting, a statistical technique that reweights the two groups so that measured baseline characteristics are balanced, mimicking some of the advantages of randomization.

The results were striking. Respiratory support escalation occurred in only 6 of 83 infants, or 7.2 percent, in the laryngeal mask group, compared with 20 of 51 infants, or 39.2 percent, in the intubated group. After weighting, the use of a laryngeal mask airway was associated with roughly a 64 percent lower risk of escalation relative to endotracheal intubation, with a risk ratio of 0.36 and a 95 percent confidence interval of 0.15 to 0.88, a difference that remained statistically significant at a P value of 0.026. In secondary unadjusted analyses, the pattern held: 90.4 percent of laryngeal mask infants had returned to their baseline level of respiratory support by 24 hours, versus 66.7 percent of intubated infants, and unplanned reintubation was needed in 1.2 percent of the laryngeal mask group compared with 9.8 percent of the intubated group.

The mechanisms behind these differences are plausible from first principles. Endotracheal intubation in a preterm infant is technically demanding; the narrow, floppy airway offers little margin for error, and each laryngoscopy can provoke reflex bradycardia, desaturation and airway trauma. The tube itself bypasses the larynx, eliminating the warming, humidification and filtration the upper airway normally provides, and it can trigger bronchial irritation and laryngeal edema that persist after extubation. Extubation is its own stress test, requiring the infant to coordinate breathing through a newly irritated airway. A laryngeal mask airway, by contrast, avoids direct tracheal instrumentation, can often be inserted with less stimulation, and is removed with less disturbance, allowing a smoother transition back to the infant’s preoperative respiratory regimen, whether that was room air, nasal cannula or noninvasive support.

The study extends earlier observations in an important direction. A 2025 analysis published in the same journal found that airway management might influence postoperative ventilation needs in preterm infants after laser treatment for retinopathy of prematurity, a longer and more painful procedure. The Beijing team deliberately focused on the briefer setting of intravitreal injection, where the anesthetic exposure is shorter and the argument for minimizing airway instrumentation is arguably stronger. Their use of inverse probability of treatment weighting also places the work among a growing family of studies, including randomized trials comparing supraglottic devices with endotracheal tubes in former preterm infants and retrospective comparisons in hernia surgery, that collectively point toward gentler airway strategies for this population. European Society of Anaesthesiology and Intensive Care guidelines on neonatal and infant airway management provide a framework for individualized device selection, and this study offers data specifically relevant to the ophthalmic operating room.

The authors are careful about the limits of their evidence. This was a single-center retrospective cohort, and the findings are associative and hypothesis-generating rather than proof of causation. Clinicians chose the airway device, and although weighting balanced the measured characteristics, unmeasured factors, such as the severity of underlying lung disease or the anesthesiologist’s judgment about airway difficulty, could still have influenced both device selection and outcomes. The conclusions apply only when laryngeal mask placement is technically feasible and clinically appropriate; infants with difficult airways, high oxygen requirements or other contraindications may still benefit from a secured endotracheal tube. The researchers call for prospective multicenter studies to confirm the association and to define which infants stand to gain the most from a supraglottic approach.

Even so, the practical implications are immediate and compelling. For neonatologists and anesthesiologists planning an intravitreal injection, the study suggests that the airway decision should be treated as a modifiable risk factor rather than a routine default. Every avoided intubation spares a fragile infant the trauma of laryngoscopy, the irritation of a tracheal tube and the physiologic cost of extubation, and the data indicate that this sparing translates into measurably faster recovery of baseline respiratory support. As anti-VEGF injections become an ever more common treatment for retinopathy of prematurity worldwide, the number of preterm infants passing through operating rooms for this brief procedure will continue to grow. If larger prospective trials confirm what this Beijing cohort observed, a simple change in airway practice could quietly prevent a meaningful share of postoperative respiratory complications in some of medicine’s most vulnerable patients, turning a routine anesthetic choice into a genuine intervention for lung protection.

Subject of Research: Airway management strategies and postoperative respiratory outcomes in preterm infants receiving intravitreal injection for retinopathy of prematurity

Article Title: Airway management and postoperative respiratory recovery after intravitreal injection in preterm infants

Article References: CHEN, Y., CHENG, Y., YAN, F., PAN, S., & HAN, D. (2026). Airway management and postoperative respiratory recovery after intravitreal injection in preterm infants. Pediatric Research. https://doi.org/10.1038/s41390-026-05512-4

Image Credits: AI Generated

DOI: 10.1038/s41390-026-05512-4

Keywords: retinopathy of prematurity, preterm infants, laryngeal mask airway, endotracheal intubation, intravitreal injection, ranibizumab, general anesthesia, respiratory support, neonatal airway management, inverse probability weighting, Pediatric Research, postoperative recovery

The prize itself carries a layered history. Known previously as the Yergin-New International Prize for Biomedical Research, it was renamed this year in recognition of the Yergin family’s longstanding support of the program. It commemorates Maria I. New, MD, the groundbreaking Mount Sinai pediatric endocrinologist who passed away in 2024 and whose six-decade career transformed the understanding and treatment of adrenal steroid disorders. The prize, now in its fifth year, is awarded annually to a distinguished physician-scientist whose lifetime achievements have led, or may lead, to new ways to prevent and treat human disease, and it has quickly become regarded as one of the foremost international honors in medical research.

Ferrara will receive a $50,000 award and deliver the Yergin Family Distinguished Lecture during a ceremony at Mount Sinai in New York City on Wednesday, November 18. The recognition caps a career that has already earned election to both the National Academy of Sciences and the National Academy of Medicine, along with the 2010 Lasker-DeBakey Clinical Medical Research Award, the 2013 Breakthrough Prize in Life Sciences, and the 2014 Canada Gairdner International Award. Together, these honors trace an unusually complete arc from basic discovery to clinical revolution.

The scientific story began in earnest in 1989, when Ferrara and his colleagues isolated and cloned VEGF, finally pinning down the biological signal responsible for angiogenesis, the formation of new blood vessels. The problem they tackled had puzzled vascular biologists for decades. Tumors, embryonic tissues, and healing wounds all emit some diffusible factor that coaxes nearby capillaries to extend toward them, but the identity of that factor remained elusive. By purifying and cloning the molecule, Ferrara’s team gave the field both a concrete target and a powerful set of experimental tools, including antibodies and genetic models that could test what VEGF actually does in living organisms.

Subsequent work revealed a biology of elegant duality. VEGF is indispensable for normal blood-vessel development, guiding the vascular system as it wires the embryo and maintains tissue health in adulthood. Yet the same signaling pathway, when overactive, becomes an engine of disease. Ferrara’s laboratory demonstrated that tumors exploit VEGF to sustain angiogenesis, supplying themselves with the oxygen and nutrients needed to grow beyond a few millimeters. In the eye, excessive VEGF drives the abnormal, leaky vessel growth that destroys vision in neovascular age-related macular degeneration, diabetic retinopathy, and other retinal diseases. The insight that a single pathway could be both essential and pathological set the stage for a new therapeutic strategy: block the signal, and starve the disease.

That strategy bore fruit in oncology first. Ferrara’s group showed that neutralizing VEGF could slow tumor growth in preclinical models, an achievement that led directly to bevacizumab, a monoclonal antibody designed to bind VEGF and prevent it from activating its receptors on blood-vessel cells. In 2004, the U.S. Food and Drug Administration approved bevacizumab for metastatic colorectal cancer, making it the first anti-angiogenic cancer therapy ever approved. Anti-VEGF approaches have since become part of standard treatment for several malignancies, including colorectal, kidney, lung, cervical, and ovarian cancers. In hepatocellular carcinoma, combinations of anti-VEGF drugs with immunotherapy are now standard of care, reflecting a growing understanding that pruning a tumor’s vasculature can also reshape the immune environment around it.

The ophthalmic branch of the story proved equally transformative. Ferrara and his collaborators established that VEGF is a key driver of neovascular age-related macular degeneration, in which rogue vessels invade the retina and leak fluid into tissue that must remain dry and precisely layered to support sight. Their work led to ranibizumab, an antibody fragment engineered for intraocular use, and helped establish anti-VEGF injection therapy as the standard of care for several serious eye disorders. For patients who once faced inevitable central vision loss, the ability to preserve or even improve sight through regular treatment has been one of the most consequential clinical advances of the past two decades.

Leaders at Mount Sinai framed the award as a case study in the value of fundamental research. “Dr. Ferrara’s work is a remarkable example of how a fundamental discovery in biology can change the course of medicine,” said Mone Zaidi, MD, PhD, MACP, Director of Mount Sinai’s Institute for Translational Medicine and Pharmacology and Mount Sinai Professor of Clinical Medicine. “By identifying VEGF and demonstrating its role in blood-vessel growth, he opened the door to treatments that have changed outcomes for patients with cancer and serious eye diseases around the world.” Daniel Yergin, PhD, the Pulitzer Prize-winning author and economic historian who endowed the prize along with his wife, foreign policy expert Angela Stent, PhD, echoed that theme: “Napoleone Ferrara’s discovery demonstrates the extraordinary impact that fundamental biomedical research can have on human health. His work has transformed the treatment of cancer and blinding eye diseases and continues to influence the development of new therapies.”

Ferrara’s laboratory has not rested on its accomplishments. His current research continues to probe VEGF and other pathways governing blood-vessel growth, with two clinical problems in sharp focus. The first is treatment burden: patients with retinal disease typically require frequent intraocular injections, and his team is developing longer-acting therapies that could extend the interval between treatments. The second is geographic atrophy, the advanced, dry form of age-related macular degeneration, for which treatment options remain limited and which represents one of the largest unmet needs in ophthalmology. Both efforts extend the same logic that produced the original breakthrough, namely that understanding the molecular machinery of the vasculature reveals new points of therapeutic intervention.

The selection process behind the award reflects its international ambitions. Winners are chosen by a jury of distinguished physician-scientists chaired by Dr. Zaidi. The 2026 jury included Nobel laureate Aaron Ciechanover of the Technion in Haifa; Nancy Andrews of Boston Children’s Hospital; Michael J. Welsh of the University of Iowa; Jeffrey Friedman of The Rockefeller University and the Howard Hughes Medical Institute; and Anna Wedell of the Karolinska Institutet in Stockholm. “We are grateful to the distinguished members of the international jury for dedicating their time and expertise to reviewing this year’s exceptional group of nominees and selecting Dr. Ferrara as the recipient,” Dr. Zaidi said. Eric J. Nestler, MD, PhD, Dean of the Icahn School of Medicine at Mount Sinai and Chief Scientific Officer of the Mount Sinai Health System, noted that the award was first established in honor of Dr. New and her extraordinary legacy, and expressed gratitude for the vision of Daniel Yergin and Angela Stent in endowing the program to live in perpetuity. “Dr. Ferrara’s achievements reflect the lasting impact of research that begins with fundamental questions and ultimately changes the way diseases are treated,” Nestler said. Administered by Mount Sinai’s Institute for Translational Medicine and Pharmacology, the prize stands as both a tribute to Maria New’s legacy and a reminder that the path from a cloned molecule to medicines used around the world often begins with a single, persistent question about how life works.

Subject of Research: Award of the 2026 Yergin Family International Prize for Biomedical Research to VEGF discoverer Napoleone Ferrara

Article Title: Napoleone Ferrara, MD, receives 2026 Yergin Family International Prize for Biomedical Research

Article References: Napoleone Ferrara, MD, receives 2026 Yergin Family International Prize for Biomedical Research. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: Napoleone Ferrara, VEGF, angiogenesis, Yergin Family Prize, Mount Sinai, bevacizumab, ranibizumab, age-related macular degeneration, cancer therapy, anti-angiogenic treatment, retinal disease, biomedical research award