A male infant presents to the emergency department at one week of age. He is pale and floppy. He was born by SVD at term weighing 3.5kg and discharged without complication. There were no risk factors for neonatal sepsis. The baby’s mother describes poor feeding.
He has a respiratory rate of 70 with mild intercostal recession and pulse oximetry saturations of 65%. Heart rate is 185 with a capillary refill time of 5 seconds and you score him P on AVPU. There are no cardiac murmurs but peripheral pulses are barely palpable and he is cold and mottled. There is no abdominal distension, fontanelle is soft and pupils are equal and reactive.