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D-Penicillamine for preventing retinopathy of prematurity in preterm infants
D L Phelps1, L Lakatos, J L Watts
1Pediatrics and Ophthalmology, University of Rochester, Box 651, Pediatrics, 601 Elmwood Ave, Rochester, New York 14642, USA. dale_phelps@urmc.rochester.edu
Insights
Prophylactic d-penicillamine may reduce acute retinopathy of prematurity (ROP) in very low birth weight infants but does not affect survival rates. Further research is warranted, with careful monitoring for potential side effects.
Area of Science:
- Neonatal Medicine
- Ophthalmology
- Pharmacology
Background:
- Retinopathy of prematurity (ROP) is a significant concern in very low birth weight infants.
- Early identification and intervention strategies for ROP are crucial for improving infant outcomes.
Purpose of the Study:
- To evaluate the prophylactic effect of d-penicillamine on the incidence of acute or severe ROP in very low birth weight infants.
- To assess the safety profile of d-penicillamine, including its impact on mortality and potential side effects.
Main Methods:
- Systematic review of randomized and quasi-randomized controlled trials involving d-penicillamine administration in infants under 2000g birth weight.
- Inclusion of case series to identify potential adverse events.
- Independent data extraction by three reviewers with consensus and analysis following Neonatal Cochrane Review Group standards.
Main Results:
- Two randomized trials indicated a significantly lower incidence of acute ROP in infants treated with d-penicillamine (RR 0.09, 95% CI [0.01,0.71]).
- No significant effect on mortality rates was observed (RR 0.99, 95% CI [0.70,1.39]).
- No drug-related side effects were reported in the ROP trials; however, other reports noted skin rashes and vomiting in infants treated for hyperbilirubinemia.
Conclusions:
- D-penicillamine appears to reduce the incidence of acute ROP in very low birth weight infants.
- The drug is unlikely to impact infant survival.
- Further investigation in a broader population is justified, with careful monitoring for adverse events.
Background:
This section is under preparation and will be included in the next issue.
Objectives:
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?
Search Strategy:
Searches were made of multiple electronic databases, previous reviews including cross references, abstracts, conference/symposia proceedings, and expert informants.
Selection Criteria:
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.
Data Collection And Analysis:
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.
Main 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.
Reviewer'S 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.