Administration of indomethacin can result in closure of a patent ductus arteriosus (PDA) in a newborn infant secondary to inhibition of prostaglandin synthesis. It should not be used if certain contraindications are present, and an alternative method of closure should be selected.


Contraindications to use of indomethacin in a newborn infant with a PDA:

(1) severe hyperbilirubinemia (requirement for exchange transfusion, indirect bilirubin > 10 mg/dL)

(2) renal failure (serum creatinine > 1.4 mg/dL or > 1.8 mg/dL; serum BUN > 35 mg/dL or > 50 mg/dL; oliguria or anuria)

(3) thrombocytopenia (variable cutoffs for the platelet count reported: < 100,000 per µL, < 60,000 per µL, < 50,000 per µL)

(4) clinical evidence of a bleeding disorder (hematuria, oozing from skin puncture sites, blood in the endotracheal aspirate, GI bleeding with blood in the stools)

(5) clinical evidence of or risk factors for necrotizing enterocolitis (NEC)


Relative contraindications:

(1) failure of 2 doses of indomethacin to result in closure

(2) premature infant with very low birthweight (< 1,000 according to Little et al; < 800 g according to Trus), due to high rate of failure and high rate of complications


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