An 8 week-old boy is sent to your E.D. by his doctor because he has decreased activity and appears ill. He was doing well until yesterday when he developed cold symptoms and decreased appetite.The child became less active and was noted to have a change in skin color.

He was a 1590gm 30-week premie, uncomplicated delivery. He required three days of mechanical ventilation for RDS but is not felt to have any residual lung damage. He has a resolving grade II-III intraventricular hemorrhage. He was discharged after birth on day of life 28 at a weight of 2190gm.

No meds or allergies

Appearance:	VS Temp 91.9F(rectal), HR 130, RR 44, Sat 80%, BP 83/63. He appears toxic.
HEENT:	NC/AT, flat fontanels, has rhinorrhea
Lungs:	fair aeration, no rales, no wheezes
Heart:	fast rate, no murmurs
Abdomen:	soft, benign, no hepatosplenomegaly
Extremities:	mottled skin, 2+pulses, cap refill 2 sec
Neuro:	Awake, fair tone, decreased spontaneous movements