title: D-Penicillamine for preventing retinopathy of prematurity in preterm infants.
abstract: BACKGROUND
  This section is under preparation and will be included in the next issue.
  
  
  OBJECTIVE
  To answer the question: Among very low birth weight infants, what is the effect of prophylactic administration of d-penicillamine on the incidence of acute ROP or severe ROP, and side effects including death?
  
  
  METHODS
  Searches were made of multiple electronic databases, previous reviews including cross references, abstracts, conference/symposia proceedings, and expert informants.
  
  
  METHODS
  Randomized or quasi-randomized controlled trials that administered d-penicillamine to infants less than 2000g birth weight within the day following birth were considered relevant to this review. Additional case series were examined for potential side effects.
  
  
  METHODS
  Data on clinical outcomes were excerpted by 3 reviewers independently, and consensus reached. Data analysis was conducted according to the standards of the Neonatal Cochrane Review Group.
  
  
  RESULTS
  Two randomized trials on the effects on ROP were identified. When combined, they showed a significantly lower incidence of acute ROP in the treated infants, relative risk of 0.09, 95% CI [0.01,0.71]. Severe stages of ROP could not be analyzed. There was no effect on death rates, relative risk 0.99 95% CI [0.70,1.39]. No side effects were reported, and follow up at one year revealed no significant differences in spasticity or developmental delay, although there were more rehospitalizations among the controls. In other reports of using d-penicillamine in over 140 infants for hyperbilirubinemia, skin rashes were reported in 2 infants and one had vomiting that may have been related.
  
  
  CONCLUSIONS
  D-penicillamine is unlikely to affect survival, and may reduce the incidence of acute ROP among survivors. Studies to date justify further investigation of this drug in a broader population; careful attention to possible side effects is needed.
authors.affiliation: Pediatrics and Ophthalmology, University of Rochester, Box 651, Pediatrics, 601 Elmwood Ave, Rochester, New York 14642, USA. dale_phelps@urmc.rochester.edu
authors.forename: D L
authors.initials: DL
authors.lastname: Phelps
authors.forename: L
authors.initials: L
authors.lastname: Lakatos
authors.forename: J L
authors.initials: JL
authors.lastname: Watts
mesh_terms: D002614:Chelating Agents / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D010396:Penicillamine / Q000627:therapeutic use*; D012178:Retinopathy of Prematurity / Q000517:prevention & control*
chemical_list: D002614:Chelating Agents; D010396:Penicillamine