This study comprises 120 full-term infants with ABO hemolytic disease admitted to the neonatal department during a period of 60 months from 1970-1975. During the first 30 months newborns (n = 61) received no D-penicillamine therapy, whereas all infants (n = 59) received this treatment (300-400 mg/kg/day, divided into 4 equal doses, for 2-5 days) during the last 30 months. The patients were further subdivided into two groups according to the point of time when D-penicillamine treatment was begun, viz. group I (34 treated and 34 control infants) within the first 24 h of life; group II (25 treated and 27 control infants) after the third day of life. In group I D-penicillamine therapy caused a marked decline of serum bilirubin concentrations at a time when such levels were rising in the control infants. The number of exchange transfusions per infant was 1.32 in the control and 0.11 in the D-penicillamine-treated infants. In group II D-penicillamine considerably reduced the number of exchange transfusions (0.70:0.24 = control:treated) but the difference was statistically not significant. In the latter patients the mean bilirubin values showed a smaller difference compared to the controls than in group I. Since group I represented the results of early or preventive treatment, while group II those of late or therapeutic treatment, it is obvious that, for ensuring success, D-penicillamine treatment should be begun as early as possible in ABO hemolytic disease of the newborn.

A 3-day D-penicillamine treatment of neonatal rats caused a significant decrease in heme oxygenase activity. This change was not observed in adult rats. The data indicate age-related differences in the effects of D-penicillamine.

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