RANDOMIZED CONTROLLED TRIAL OF ALLOPURINOL PROPHYLAXIS IN VERY PRETERM INFANTS

Allopurinol, an inhibitor of xanthine oxidase (an enzyme capable of ge nerating superoxide radicals following hypoxiaischaemia), was investig ated in preterm infants to determine its ability to prevent the compli cations of neonatal intensive care which may be associated with oxidat ive injury. Four hundred infants of between 24 and 32 weeks' gestation were randomly allocated to receive enteral allopurinol (20 mg/ml) or an equivalent dose of placebo for seven daily doses. At admission, pla sma hypoxanthine concentrations were significantly higher in infants w ho subsequently developed periventricular leucomalacia (PVL), bronchop ulmonary dysplasia (BPD), or retinopathy of prematurity (ROP), but the re was no difference in the primary endpoint (PVL) between the treated and control groups. The failure of allopurinol prophylaxis in this gr oup of infants is probably related to the complex nature of the pathol ogical processes and to the timing of treatment. If oxidant injury is an important mechanism of cellular injury in these preterm infants, an alternative biochemical modulator would be required, or a combination of agents might be effective.