Eighteen days old, warm, and not interested in feeding

A term newborn's parents bring him in because he feels hot and has slept through two feeds. He looks all right in the waiting room.

Age18 daysWeight3.6 kgVitals read against the newborn band

Pediatrics

18 days old· newborn3.6 kgboy, Pediatric emergency, room 2Fictitious educational patient

Caregiver: Father: 'He felt hot this afternoon, 38.3 on the ear thermometer. He slept through his 2 o'clock and his 5 o'clock feeds, which he never does. He seems fine now though, he is looking around.'
Feeding: Breastfed, every 3 hours until today; missed two feeds.
Intake and output: Two wet diapers since the morning.
Birth: Term, vaginal delivery, birth weight 3.3 kg. Mother's group B streptococcus swab negative. Membranes ruptured 6 hours before delivery. No maternal fever.
Immunizations: Hepatitis B given at birth.

Term, uncomplicated birth

Day 18 · 18:20

Triage

Rectal temperature at triage is 38.4. He is pink, awake, moving all limbs, with a soft flat fontanelle. The triage note says 'well-appearing'.

Vitals

HR 172RR 48SpO2 98Newborn band · HR 100 to 205 · RR 30 to 53

HR172BP72/44RR48SpO298%T38.4high for age

Read against the newborn band (birth to 28 days): HR 100 to 205 awake, RR 30 to 53, hypotension below 60 systolic at the youngest age in the band. Fever, crying and pain move these numbers.

He looks well. What does the age require?

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