A 1200-gram preterm infant at 30 weeks gestation is found to have a haemodynamically significant patent ductus arteriosus (PDA) on echocardiography with left-to-right shunting and pulmonary congestion on day 3. Which pharmacological agent is the current first-line treatment?
- A Indomethacin 0.2 mg/kg IV every 12 hours for 3 doses
- B Ibuprofen (oral or IV) 10 mg/kg loading dose followed by 5 mg/kg at 24 and 48 hours ✓
- C Paracetamol (acetaminophen) 15 mg/kg/dose every 6 hours for 3–7 days
- D Furosemide 1 mg/kg IV to reduce pulmonary congestion
Explanation
Ibuprofen is currently preferred over indomethacin for pharmacological closure of haemodynamically significant PDA in preterm neonates because it has similar efficacy but a better renal safety profile (less decrease in urine output and creatinine rise). The regimen is ibuprofen 10 mg/kg on day 1, 5 mg/kg on days 2 and 3. Both ibuprofen and indomethacin work by inhibiting COX enzymes, reducing prostaglandin E2 synthesis which normally keeps the ductus open. Paracetamol is emerging as an alternative (especially for ibuprofen contraindications like thrombocytopenia) but is not yet the standard first-line. Furosemide alone does not close the PDA and may even increase ductal flow.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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