A 30-week preterm neonate is found to have a large patent ductus arteriosus causing significant left-to-right shunting with hyperdynamic precordium, bounding pulses, and wide pulse pressure. Indomethacin treatment is being considered. Which is a contraindication to indomethacin use for ductal closure?
- A Postnatal age of 3 days
- B Serum creatinine of 0.6 mg/dL
- C Platelet count of 95,000/mm³ (thrombocytopenia) ✓
- D Concomitant phototherapy for jaundice
Explanation
Contraindications to indomethacin (COX inhibitor) for PDA closure include: thrombocytopenia (platelets <60,000–100,000/mm³) due to platelet dysfunction risk; renal impairment (creatinine >1.8 mg/dL or oliguria <1 mL/kg/hour); necrotizing enterocolitis or intestinal perforation; active bleeding (IVH grade III/IV, clinically significant GI bleeding); and significant hyperbilirubinemia (indomethacin displaces bilirubin from albumin). Platelet count of 95,000 is borderline low and is a contraindication in many protocols. Phototherapy for jaundice is not a contraindication. Postnatal age of 3 days is within the therapeutic window.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.