A preterm neonate born at 28 weeks develops hypotension on day 1. Echocardiography reveals a large patent ductus arteriosus (PDA) with left-to-right shunt. Indomethacin is planned. Which of the following is an absolute contraindication to indomethacin in this neonate?

• A Platelet count 80,000/mm³
• B Serum bilirubin 8 mg/dL
• C Urine output 0.8 mL/kg/hr
• D Serum creatinine 1.8 mg/dL ✓

Explanation

Indomethacin is contraindicated when serum creatinine exceeds 1.8 mg/dL because the drug further reduces renal prostaglandin synthesis, worsening renal perfusion and causing oliguria or acute kidney injury. Thrombocytopenia below 60,000/mm³ (not 80,000) is the commonly cited platelet threshold. Bilirubin elevation is a concern but not an absolute contraindication unless critically high, and moderate thrombocytopenia without active bleeding is a relative rather than absolute contraindication.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.