A 26-day-old girl who was born at 39 weeks and 4 days’ gestational age via normal spontaneous vaginal delivery is brought in by ambulance for an episode of limpness and pallor. Her mother reports that she had been doing well until the morning of presentation when she became irritable during a diaper change, then became pale and limp. The episode was brief and had resolved by the time of paramedic arrival. This has not happened before. There are no other symptoms, no changes in feeding patterns, and review of systems is unremarkable. Prenatal, perinatal, postnatal courses are reviewed and noted to be uncomplicated, though there is no record of a prenatal anatomy ultrasound.

Her temperature is 97.9oF (36.6oC), respirations are 36 breaths/min, heart rate is 160 beats/min, blood pressure is 88/63 mmHg, and oxygen saturation is 100% on room air. Physical exam reveals normal facies, regular...

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