A baby boy is born by vaginal delivery after a 35-week gestation. During the week prior to delivery, his mother experienced low-grade fever, coryza, diarrhea, abdominal cramping, and mild vaginal bleeding. A small placental abruption was diagnosed, and labor was induced. In the first few hours after birth, the baby develops poor perfusion and tachypnea. Blood cultures are drawn, and he is treated with ampicillin and gentamicin for 5 days and improves. The cultures show no growth.

On the fifth day of life, just prior to discharge, the infant suddenly becomes apneic and again demonstrates poor perfusion. He is intubated, stabilized, and again evaluated for sepsis, including lumbar puncture. Antibiotics are changed to vancomycin and cefotaxime. Acyclovir is added.

His white blood cell (WBC) count is 14.1×103/mcL (14.1×109/L), with an absolute neutrophil count of 13.1×103/mcL (13.1×109/L) and bands noted on smear. Cerebrospinal...

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