A 2-week-old premature infant (32 weeks gestation) presents with increased work of breathing. Vital signs show BP 68/38 mmHg, HR 160/min, RR 48/min, SpO2 98% on room air. Physical examination reveals a continuous "machinery" murmur at the infraclavicular region, widened pulse pressure, and bounding pulses. Chest X-ray demonstrates pulmonary edema. Echocardiography confirms left-to-right ductal shunting. The infant has no cyanosis. Which medication would be most appropriate to initiate?
- A)Furosemide alone
- B)Indomethacin or ibuprofenGABARITO
- C)Prostaglandin E1
- D)Captopril
- E)Digoxin for rate control
Explicação
This premature infant has a patent ductus arteriosus (PDA) with left-to-right shunting, causing the classic continuous 'machinery' murmur, widened pulse pressure (bounding pulses), and pulmonary edema (increased work of breathing). NSAIDs like indomethacin or ... Ver explicação completa e trilha adaptativa →