We investigate the influence of negative-energy states in proton-proto
n bremsstrahlung in a fully relativistic framework using the T matrix
of Fleischer and Tjon. The contribution from negative-energy states in
the single-scattering diagrams is shown to be large, indicating that
relativistic effects are important. The rescattering contribution comp
ensates some of the effect, which is shown to be a consequence of a lo
w-energy theorem. The net effect of negative-energy states nevertheles
s is of the order of 20% at higher energies. We investigate retardatio
n effects in the nucleon-nucleon (NN) interaction by means of a one-pi
on exchange model, which gives effects of the order of 15% at the pion
-production threshold. We furthermore modify the NN T matrix tb incorp
orate some of these effects, and find that on the level of single-scat
tering contributions they are of the order of 10%. We show predictions
at incoming proton energy T-lab=190 MeV, where high accuracy measurem
ents are being done at KVI, and conclude that even at these relatively
low energies off-shell effects in the NN interaction and contribution
s from negative-energy states clearly show up.