A 1-week-old infant presents to the emergency department with a 1-day history of poor feeding, pallor, diaphoresis, and increasing somnolence. She was born at term, and the delivery was uncomplicated. On physical examination, her heart rate is 180 beats/min, respiratory rate is 90 breaths/min, and blood pressure is 50/30 mm Hg. Her breath sounds are shallow, and cardiac evaluation reveals no murmurs but a gallop rhythm. Her liver is palpable at 3 cm below the costal margin. Her extremities are cool, pale, and mottled, and she has poor distal pulses. After you administer normal saline at 20 mL/kg, her heart rate is 194 beats/min.
Of the following, the MOST appropriate next step is
A. Adenosine infusion at 50 mcg/kg
B. Computed tomography scan of the head
C. Dopamine infusion at 10 mcg/kg per minute
D. Lumbar puncture followed by antibiotics
E. Normal saline infusion at 20 mL/kg
ANSWER ON THURSDAY AT 10 AM
C
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