A 2-day-old male neonate presents to the emergency department with increasing cyanosis and difficulty breathing. The baby was born at term via vaginal delivery with no complications during pregnancy or birth. The Apgar scores were 8 and 9 at 1 and 5 minutes, respectively. On day 2 of life, the parents noticed the baby turning blue during feeding and being less active. The family denies any history of congenital heart disease. On physical examination, the baby appears cyanotic with oxygen saturation of 78% on room air. There is a systolic murmur best heard at the left sternal border and diminished peripheral pulses. The neonate’s respiratory rate is 70 breaths/min, and he shows signs of poor perfusion with cool extremities. Initial workup includes a chest X-ray showing cardiomegaly and reduced pulmonary vascular markings. An echocardiogram reveals severe coarctation of the aorta, a ductal-dependent cardiac lesion where systemic blood flow relies on a patent ductus arteriosus (PDA) to bypass the narrowing in the aortic arch. Which of the following medications is used to keep the ductus arteriosus patent and can be life-saving in neonates with ductal dependent cardiac lesions?
