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During the initial minutes of the scenario, learners of all levels should collect a thorough history from the patient's parent/s and perform a complete physical exam. Initial lab tests and imaging studies should be ordered after this assessment is complete. All learners should request a heelstick glucose (prompted by the nurse if the learner fails to request it).

Over the next five minutes, the patient will deteriorate regardless of interventions, becoming less responsive with hypotension, increased respiratory rate, and hypoxia. Eventually, there will be episodes of bradycardia with short apneic episodes.

For novice learners, not trained to perform intubation on infants, the use of bag–valve mask (BVM ) ventilation for supplemental oxygen will stabilize the patient until the NICU team arrives. They may consult anesthesiology as well.

For more advanced learners, intubation will be required because of impending respiratory failure and worsening lethargy.

If there is a delay in providing advanced airway interventions (BVM and/or intubation), the patient will progress into a pulseless electrical activity (PEA ) rhythm and require cardiopulmonary resuscitation (CPR ). After two minutes of appropriate pediatric CPR, the patient will regain pulses.

Advanced learners will need to initiate vasopressors for persistent hypotension. If the learners do not order vasopressors, the nurse may prompt them by mentioning that the blood pressure remains abnormally low and the full IV fluid bolus has already been given.

Once the airway and hypotension are addressed (or upon finishing CPR), the learners will receive any remaining results not yet reported. They should then communicate their concern for NEC with pediatric surgery as well as the NICU/PICU team for admission and intervention. The case will end upon appropriate consultation with these teams.