A 3-week-old male infant born at 28 weeks gestation presents with poor feeding and weight loss. On examination, he is tachypneic (RR 58/min), tachycardic (HR 172 bpm), and afebrile. A continuous 'machinery' murmur is heard at the left infraclavicular region. Hepatomegaly is noted on palpation. Chest X-ray demonstrates cardiomegaly with pulmonary edema and increased pulmonary vascular markings. Echocardiography confirms a patent ductus arteriosus (PDA) with significant left-to-right shunting and evidence of left atrial enlargement. The infant is currently on supplemental oxygen and mechanical ventilation. Which of the following is the most appropriate next step in management?
- A)Initiate prostaglandin E1 infusion to maintain ductal patency
- B)Administer furosemide and fluid restriction while observing for spontaneous closure
- C)Start indomethacin therapy to promote ductal closureGABARITO
- D)Perform immediate surgical ligation under emergency conditions
- E)Administer sildenafil to reduce pulmonary vascular resistance
Explicação
Indomethacin (or ibuprofen) is the first-line pharmacologic treatment for a hemodynamically significant PDA in a preterm infant. NSAIDs inhibit prostaglandin synthesis, promoting ductal closure. In this case, the infant shows clinical signs of PDA-related hear... Ver explicação completa e trilha adaptativa →