An 11-day-old female presents to her primary care physician's office with a 1-day history of decreased oral intake and reduced energy. Today she developed increased work of breathing at home. On physical examination, the infant exhibits hypothermia, and the physician refers her to the emergency department where her rectal temperature is measured at 94.9°F (35.0°C). The parents deny any ill contacts, and review of systems is negative for rhinorrhea, coughing, vomiting, and diarrhea.

In the emergency department, a complete blood count and blood and urine cultures are obtained. While in the process of undergoing a lumbar puncture, the infant has an acute episode of apnea and bradycardia that does not resolve with stimulation. She receives chest compressions and a dose of atropine and is endotracheally intubated. Shortly thereafter, she has an episode of “eye rolling” that appears to be “seizure-like.” Head computed tomography (CT) scan is read as normal. On...

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