A healthy 3.6-kg baby boy, Riley, is born to a 25-year-old nulliparous mother in a community hospital. The family doctor notes that the boy's genital development is somewhat atypical. Her examination reveals that the infant has hypospadias, chordee and undescended testes. A plan is put in place for the infant to be seen by a pediatric urologist in 6 weeks with a view to eventual surgical correction. At one week of age, the infant is brought to the family physician's office for routine follow up. Riley's mother comments that he seems to be breastfeeding poorly. She describes him as increasingly uninterested in feeding and is concerned that he seems to be "spitting up" a lot. The infant now weighs 3.1 kg. A recommendation is made to begin some formula supplementation to help support weight gain. At 10 days of age, Riley's mother finds him in his crib, non-rousable, cool, mottled and covered in vomit. Riley is rushed to the emergency department via ambulance. In the emergency room, resuscitative measures are initiated. The airway is suctioned. He is intubated and hand-bagged to achieve ventilation. A 20 mL/kg bolus of normal saline is administered.