Co-administration of indomethacin with a postnatal corticosteroid may increase the risk of which complication?

• A. Necrotizing enterocolitis
• B. Neurodevelopmental impairment
• C. Spontaneous intestinal perforation
• D. None of the above

Answer: (C)

Co-administration of indomethacin with a postnatal corticosteroid increases the risk of spontaneous intestinal perforation. Indomethacin lowers prostaglandin levels and can decrease intestinal blood flow, while corticosteroids can weaken the gut wall and impair tissue integrity. Together, these effects raise the likelihood of a perforation in preterm infants, independent of NEC. While NEC is a concern in this population, the specific combination most strongly linked to an acute perforation is spontaneous intestinal perforation.