Osler Round 6 - 3-days-old baby with refusal to breastfeed

The clinical case

A 3-day-old term female neonate, was brought to the health facility from home in a rural village by her mother. The mother reported that the baby had been experiencing excessive, inconsolable crying followed by a total refusal to breastfeed for the past 12 hours. The mother noted that the baby had become progressively weak and was feeling hot to the touch. She was delivered at home under the supervision of her mother-in-law. The neonate did not cry immediately at birth, but later cried after rubbing the abdomen and shaking the baby vigorously. Upon arrival at the health facility, the baby's vitals were: temperature 38.8 degrees Celsius, respiratory rate 78 breaths per minute, and heart rate 165 beats per minute. The physical examination revealed a moderately lethargic, ill-looking neonate with a weak, high-pitched cry, and a tense anterior fontanelle. The abdomen was moderately distended with shiny skin, absent bowel sounds, and visible periumbilical erythema extending to the abdominal wall.