A male infant is born at 39 weeks’ gestational age via repeat cesarean delivery to a 36-year-old (gravida 3, para 2, term 2, living 2) woman. The prenatal history is notable for group B Streptococcus–positive maternal status; the prenatal course is otherwise benign and there is no known family history of medical disorders. The infant is vigorous at birth, with spontaneous respirations and a heart rate greater than 100 beats/min; his Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. He weighs 3,460 g (59th percentile), his head circumference is 34.5 cm (51st percentile), and length is 48.9 cm (30th percentile). The rest of his physical examination findings are normal.

The infant initially remains with his mother; however, at approximately 15 minutes of age during skin-to-skin contact with his mother, the infant is noted to be pale, with a preductal pulse oximetry oxygen saturation of 50%...

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