A 6-day-old newborn is brought to the neonatal intensive care unit due to poor feeding, lethargy, and episodes of vomiting. The infant's parents report that the urine has a distinctive sweet, maple syrup-like odor. Laboratory evaluation reveals metabolic acidosis along with elevated levels of branched-chain amino acids and their corresponding ketoacids in the blood. Which enzyme deficiency is most consistent with this patient's clinical presentation?
Vital Signs:
Laboratory Findings:
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