Paediatricsmiddle twist
A 3-day-old boy, born at term and discharged well at 24 hours, is brought back because he has become grey, floppy and uninterested in feeding over six hours. His respiratory rate is 72/min, heart rate 178/min, and his liver edge is 4 cm below the costal margin. The femoral pulses are impalpable while the brachial pulses are easily felt. Oxygen saturation is 96% in the right hand and 81% in the foot. Capillary refill is 5 seconds centrally. Blood gas shows a metabolic acidosis with lactate 8 mmol/L.
Which one of the following is the most appropriate immediate management?