A female infant is born via spontaneous vaginal delivery at 40 weeks of gestation to a 34-year-old multigravida who has diet-controlled gestational diabetes. Meconium-stained amniotic fluid is noted with rupture of membranes 3 hours before delivery. The infant is vigorous after birth, with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. The neonate’s birthweight is 4,050 g (98th percentile). The initial physical examination findings are normal and she is allowed to room in with her mother. Vitamin K is administered within 1 hour of birth.

Due to ineffective attempts at lactation, the neonate receives supplementation with term formula once during the first 24 hours. There is no documented void before 24 hours and a neonatology consultation is requested. During the physical examination in the newborn nursery, at 26 hours of age, she passes a large bloody stool with a significant amount of bright red blood. The...

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