An 11-day-old white infant is admitted with the chief complaint of poor feeding and new-onset cough. The infant was born at 35-4/7 weeks to a 26-year-old woman who is gravida 6, para 3-2-3-3; the pregnancy was complicated by preterm labor. Maternal history is significant for herpes simplex virus infection with no active lesions during the current pregnancy; she did not receive valacyclovir during pregnancy. The mother smoked half a pack of cigarettes per day, but denied alcohol and other illicit drug use. After birth, the infant was vigorous and required warmth and tactile stimulation. Apgar scores were 8 and 9 at 1 minute and 5 minutes, respectively. The infant spent 24 hours in the neonatal intensive care unit because of prematurity and was discharged after 3 days.

Ten days after birth, the mother noticed new-onset cough. Subsequently, the mother also noticed decreased oral intake, which prompted her to bring the...

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