A newborn is found to have a bicuspid aortic valve with severe coarctation of the aorta. On day 3 of life, the neonate deteriorates acutely with poor femoral pulses. What is the immediate pharmacological intervention?

• A IV furosemide and captopril
• B IV dopamine alone
• C Oral propranolol to reduce aortic gradient
• D IV prostaglandin E1 (PGE1) infusion ✓

Explanation

Critical coarctation of the aorta in neonates is a duct-dependent lesion — systemic perfusion to the lower body depends on right-to-left flow through the PDA. When the ductus closes, the neonate deteriorates with absent femoral pulses, metabolic acidosis, and cardiogenic shock. Prostaglandin E1 (PGE1, alprostadil) infusion reopens and maintains ductal patency, thereby restoring lower body perfusion and allowing stabilization before surgical or catheter-based intervention. Furosemide and captopril would be inappropriate in shock. Dopamine alone does not address the underlying ductal closure.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.