neonates born to mothers not previously exposed to pertussis or with inadequate vaccination These neonates will not have passive immunity from maternal antibodies It can present either as an early- or late-onset pneumonia after contact with an infected family member or sibling Neonates with pneumonia present with respiratory distress and increase in nasal and respiratory secretions Signs and symptoms similar to neonatal sepsis can be nonspecific ( Table 96.7 ) Viral infection with RSV, influenza, parainfluenza viruses, adenovirus, and metapneumovirus can produce a similar presentation Apnea is a common presentation in RSV infection All neonates with suspected pneumonia should receive a complete workup, including CBC, CRP, blood, urine, and CSF cultures CXR may show patchy infiltrates with air bronchograms, diffuse haziness, or lobar or segmental consolidation Pleural effusions are common but CXRs may also be normal in 15% of cases CXR in babies with C trachomatis may show hyperinflation with infiltrates Nasopharyngeal aspirates can be sent for direct immunofluorescence or PCR to diagnose chlamydial pneumonia Neonatal pneumonia should be differentiated from other pulmonary etiologies (pneumothorax) and nonpulmonary etiologies of respiratory distress (e.g., choanal atresia, tracheoesophageal fistula, CHD, and metabolic etiologies) Empiric treatment with broad-spectrum antibiotics is indicated similar to neonatal sepsis Supportive treatment including intravenous fluids, correction of electrolyte disturbances, and respiratory support should be initiated as needed Therapy should be tailored according to the organism Oral erythromycin or azithromycin is indicated for chlamydial infection Mothers and their partners should also be treated Infants born through a vaginal canal infected with chlamydia are at high risk of contracting pneumonia or conjunctivitis They should be observed for emergence of signs and symptoms Efficacy of antibiotic prophylaxis is unknown Urinary Tract Infections in the Newborn UTIs occur in 0.1% to 1% of neonates They are more common in uncircumcised males because of limited retraction and increased bacterial burden in the foreskin This holds true up to year of age, after which the incidence is higher in females E coli is responsible for 50% to 80% of UTIs E coli has increased virulence factors that facilitate adherence and propagation of the organisms Other gramnegative bacteria can be etiologic agents but gram-positive organisms may also contribute Infectious spread to the urinary system can occur hematogenously from bacteremia (30% of cases) or from an ascending infection Twenty to 50%