What is a significant reason for not giving ceftriaxone to neonates?

Ceftriaxone is contraindicated in neonates primarily due to its potential to increase the risk of biliary sludging and kernicterus. In neonates, the immature hepatic function can lead to improper metabolism and clearance of certain medications, including ceftriaxone. This antibiotic can precipitate in the bile system, leading to biliary stasis and sludge formation, which can impair bilirubin excretion.

Kernicterus, a severe form of jaundice, can arise when excessive bilirubin accumulates and subsequently deposits in the brain, leading to neurological damage. Given that neonates already have a vulnerable bilirubin handling mechanism, the use of ceftriaxone can exacerbate this situation, creating significant risks that outweigh the benefits of administering the drug in this population.

While hypotension, nephrotoxicity, and allergic reactions are concerns associated with various medications, the specific risk of biliary complications and the potential for kernicterus make ceftriaxone particularly unsuitable for neonates.