A 32-week preterm neonate is on mechanical ventilation for respiratory distress syndrome. On day 3, the nurse notices worsening oxygenation and a continuous machinery murmur at the upper left sternal border. Echocardiography confirms a hemodynamically significant patent ductus arteriosus. Which of the following is the most accurate statement regarding indomethacin use in this context?

• A It acts by blocking prostaglandin synthesis, promoting ductal constriction ✓
• B It is equally effective as ibuprofen with fewer renal side effects
• C Its prophylactic use in all VLBW neonates is now universally recommended
• D It is contraindicated if platelet count is above 80,000/mm³

Explanation

Indomethacin (a cyclooxygenase inhibitor) acts by blocking prostaglandin E2 synthesis; PGE2 keeps the ductus arteriosus patent, so blocking it promotes ductal constriction. Ibuprofen has a similar efficacy with fewer renal adverse effects compared to indomethacin (not fewer). Prophylactic indomethacin reduces severe IVH risk but does not consistently improve neurodevelopmental outcomes, so universal prophylaxis is not currently recommended. Indomethacin is contraindicated when platelet count is below 60,000/mm³, not above 80,000/mm³.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.