of neonates who develop a UTI will have a congenital abnormality of the genitourinary tract that facilitates stasis of urine or propagation of bacteria (e.g., hydronephrosis, posterior urethral valves, ectopic ureter, duplication of the collecting system, renal dysplasia) VUR may be the only abnormality Signs and symptoms are similar to those of neonatal sepsis ( Table 96.7 ) Fever and poor feeding are the most common presenting symptoms Direct hyperbilirubinemia, prolonged jaundice, or new onset of jaundice in a newborn after days of life is suspicious for a UTI One percent to 2% of babies with UTI will develop meningitis Neonates suspected of having a UTI should undergo a full sepsis workup including blood, urine, and CSF cultures Urinalysis alone for diagnosis of UTI lacks specificity and sensitivity Infants frequently void, which does not allow for an adequate concentration of nitrites or leukocyte esterase to form in the urine Urine culture should be obtained by catheterization or suprapubic aspiration and not from a bagged specimen Presence of more than 10,000 colony-forming units/mL in a catheterized urine culture with positive urinalysis or dipstick is significant Neonates should be admitted for observation and intravenous antibiotics after obtaining cultures Other Viral Infections of the Newborn Neonates often develop specific viral infections that have characteristic manifestations different from bacterial infection The goal of treatment is to determine differences between these viral infections and neonatal sepsis Often this is not possible until after admission and testing CLINICAL PEARLS AND PITFALLS Sixty percent to 80% of mothers who transmit HSV to their newborns have not had a history of a prior genital infection Consider HSV in neonates who have abnormal liver function tests Enteroviral infections are more severe in the neonate than children resulting in meningitis, acute fulminant hepatitis, and heart failure from myocarditis Consider sending enteroviral PCR from a CSF sample in babies with signs and symptoms of neonatal sepsis and high liver functions Neonatal Herpes Simplex Virus Infection Neonatal HSV disease can result from infection with HSV-1 or HSV-2 It is still very rare, occurring in only 1:3,200 deliveries Infection occurs through vertical