A randomized prospective study of the effectiveness of allopurinol (Ap), a potent and specific inhibitor of the enzyme xanthine oxidase, was performed in premature infants endangered by hypoxia. The drug was given at a dose of 20 mg/kg/day orally for 3 days. In the Ap-treated group the expected decrease in the serum concentration and urinary excretion of uric acid was accompanied by a decrease in the mortality rate of infants with idiopathic respiratory distress syndrome. In these patients a concomitant improvements in renal function, as indicated by an increased urinary flow rate and creatinine output, was also obvious. It is suggested that the observed beneficial effect is due to the specific inhibition of xanthine oxidase associated with Ap therapy leading to reduced generation of superoxide radicals and decreased urinary loss of purine.