D-Penicillamine for preventing retinopathy of prematurity in preterm infants

Qureshi, Mosarrat; Kumar, Manoj

doi:10.1002/14651858.cd001073.pub2

Cited by 20 publications

(18 citation statements)

References 39 publications

(13 reference statements)

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“…Although there are few, focused systematic reviews on the prevention of ROP, [87][88][89] this is the first comprehensive meta-analysis of interventions aimed at multiple modifiable risk factors thought to be associated with an increased incidence of ROP. Our review revealed multiple subcategories of postnatal nutritional interventions.…”

Section: Summary Of Evidencementioning

confidence: 99%

Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis

Fang¹,

Sorita²,

Carey³

et al. 2016

Pediatrics

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CONTEXT: The effectiveness of many interventions aimed at reducing the risk of retinopathy has not been well established. OBJECTIVE:To estimate the effectiveness of nutritional interventions, oxygen saturation targeting, blood transfusion management, and infection prevention on the incidence of retinopathy of prematurity (ROP). DATA SOURCES:A comprehensive search of several databases was conducted, including Medline, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus through March 2014. STUDY SELECTION:We included studies that evaluated nutritional interventions, management of supplemental oxygen, blood transfusions, or infection reduction and reported the incidence of ROP and mortality in neonates born at <32 weeks. DATA EXTRACTION:We extracted patient characteristics, interventions, and risk of bias indicators. Outcomes of interest were any stage ROP, severe ROP or ROP requiring treatment, and mortality. RESULTS:We identified 67 studies enrolling 21 819 infants. Lower oxygen saturation targets reduced the risk of developing any stage ROP (relative risk [RR] 0.86, 95% confidence interval [CI], 0.77-0.97) and severe ROP or ROP requiring intervention (RR 0.58, 95% CI, 0.45-0.74) but increased mortality (RR 1.15, 95% CI, 1.04-1.29). Aggressive parenteral nutrition reduced the risk of any stage ROP but not severe ROP. Supplementation of vitamin A, E, or inositol and breast milk feeding were beneficial but only in observational studies. Use of transfusion guidelines, erythropoietin, and antifungal agents were not beneficial. LIMITATIONS:Results of observational studies were not replicated in randomized trials. Interventions were heterogeneous across studies. CONCLUSIONS:At the present time, there are no safe interventions supported with high quality evidence to prevent severe ROP.

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Section: Summary Of Evidencementioning

confidence: 99%

Interventions To Prevent Retinopathy of Prematurity: A Meta-analysis

Fang¹,

Sorita²,

Carey³

et al. 2016

Pediatrics

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“…In a prospective controlled trial, DPA was administered to preterm infants at 26–35 weeks gestation and found to be effective for ROP with no serious adverse effects (58) and at one year follow-up, (59). Later trials refuted those findings (60,61); Superoxide Dismutase (SOD) dismutates the extremely toxic superoxide anion into H 2 O 2 and H 2 O. SOD is the first line of defense against oxidative stress in the mitochondria, with MnSOD located in the inner mitochondrial matrix. A multicenter trial of intratracheal rhSOD showed a reduction in severe ROP above stage 2 in rhSOD-treated infants born at <25 weeks (62); Lutein and zeaxanthin are antioxidants in the eye.…”

Section: Pharmacologic Interventions In Ropmentioning

confidence: 99%

Pharmacologic interventions for the prevention and treatment of retinopathy of prematurity

Beharry

Valencia

Lazzaro

et al. 2016

Seminars in Perinatology

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Retinopathy of prematurity (ROP), a significant morbidity in prematurely born infants, is the most common cause of visual impairment and blindness in children and persists till adulthood. Strict control of oxygen therapy and prevention of intermittent hypoxia are key in the prevention of ROP, but pharmacologic interventions have decreased risk of ROP. Various drug classes such as methylxanthines (caffeine), VEGF inhibitors, anti-oxidants, and others have decreased ROP occurrence. The timing of pharmacologic intervention remains unsettled, but early prevention rather than controlling disease progression may be preferred. These drugs act through different mechanisms and synergistic approaches should be considered to maximize efficacy and safety.

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“…A powerful antioxidant and a VEGF inhibitor, D-penicillamine which when used to treat other disease that premature infants have, the treated infants had less ROP occurrence. However, no significant benefits of D-penicillamine was observed for the outcomes of ROP, death or development of nerves and hence not recommended [21]. Stem cell therapy with the help of umbilical cord blood (UCB) could present as an alternative treatment for ROP in preterm infants.…”

Section: Treatmentmentioning

confidence: 99%