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Extreme heat impacts on child health and well-being due to immature thermoregulation, less sweating and a high surface-to-body mass ratio that make them more vulnerable to heat-related illness. Severe dehydration, especially if struggling with breastfeeding, renal failure and electrolyte imbalance, and neurological and cardiorespiratory failure may result. This late preterm was born healthy during a heatwave and developed lethargy and minimal responsiveness from day of life (DOL) 5, developed seizures at DOL 12, then demised at DOL 20. All hospitals involved in the diagnostic workup and treatment presumed severe sepsis and treated accordingly. However, microbiology results were always negative. In infants, especially if preterm, it is challenging to distinguish septic shock from heat-related illness, as well as other neonatal diagnoses. Medical history, including risk factors for infection and heat-related disease, must be thoroughly explored. It is important for healthcare workers and the public to be aware of potentially fatal neonatal heat-related illness.