The health of former US President George HW Bush has worsened and he is in intensive care with a "stubborn fever".
Mr Bush was admitted to the intensive care unit on Sunday and has been put on a liquids-only diet.
He has been battling bronchitis for the last month and has been in and out of hospital.
Spokesman Jim McGrath: "It's an elevated fever, so it's actually gone up in the last day or two. It's a stubborn fever that won't go away.
"He's had a series of setbacks now that have landed him in guarded condition in the intensive care unit."
Mr Bush had been making a good recovery early last week, he added.
Mr Bush, a Republican, served a single term in the White House from 1989 to 1993, despite sending US forces to victory in Iraq in the first Gulf War, expelling Saddam Hussein's forces from Kuwait.
The 88-year-old was first admitted to Methodist Hospital in Houston on November 7 for bronchitis treatment and released on November 19.
He was readmitted on November 23 after his cough flared up once more.
Doctors had initially hoped to be able to send the elder statesman home for Christmas, but instead he spent the holiday in hospital, where he was joined by his wife Barbara, son Neil and grandson Pierce.
Mr McGrath said: "I wouldn't say he was able to celebrate it in the traditional sense.
"His family was with him, and he's conscious and he's able to engage in humorous banter with his doctor."
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