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Neonatal listeriosis is a serious infection, particularly in preterm infants, requiring timely recognition and management. We report the case of a neonate born at 27+2 weeks of gestation who presented with respiratory distress and signs of sepsis. Listeria monocytogenes was identified as the causative agent through cerebrospinal fluid analysis. The infant’s clinical course was complicated by prematurity-related challenges, including intraventricular haemorrhage, hydrocephalus necessitating ventriculoperitoneal shunting and periventricular leukomalacia. Early initiation of appropriate antibiotics, alongside comprehensive intensive care management, led to stabilisation. This case underscores the importance of considering listeriosis in the differential diagnosis of neonatal sepsis and highlights the value of multidisciplinary care in managing its complications.