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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 8 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