A preterm neonate at 30 weeks gestation is treated with prophylactic indomethacin for PDA. After 2 doses, you note oliguria and rising creatinine. Which of the following is the MOST appropriate next step?

• A Continue indomethacin and add furosemide to counter renal effects
• B Switch to ibuprofen, which has fewer renal side effects than indomethacin
• C Continue indomethacin at reduced dose and restrict fluids
• D Discontinue indomethacin and reassess for PDA with echocardiography ✓

Explanation

Indomethacin inhibits prostaglandin-mediated renal afferent arteriolar dilation, causing renal vasoconstriction, oliguria, and transient rise in creatinine. When oliguria (urine output <1 mL/kg/h) or significant creatinine rise occurs, the drug should be discontinued. The PDA should then be re-evaluated by echocardiography to decide further management (repeat course, ibuprofen, or surgical ligation). Adding furosemide does not address the underlying mechanism. While ibuprofen has a better renal profile, switching in the setting of established renal dysfunction is not the immediate step—discontinuation and reassessment is.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.