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Urinary tract infections in neonates

Donough J O'Donovan, MD
Section Editors
Tej K Mattoo, MD, DCH, FRCP
Morven S Edwards, MD
Leonard E Weisman, MD
Deputy Editor
Carrie Armsby, MD, MPH


Urinary tract infection (UTI) in neonates (infants ≤30 days of age) is associated with bacteremia and congenital anomalies of the kidney and urinary tract (CAKUT). Upper tract infections (ie, acute pyelonephritis) may result in renal parenchymal scarring and chronic kidney disease. Neonates with UTI should be evaluated for associated systemic infection, and anatomic or functional abnormalities of the kidneys and urinary tract.

The epidemiology, pathogenesis, clinical features, diagnosis, and management of UTIs in neonates will be reviewed here. UTIs in older infants are discussed separately. (See "Urinary tract infections in infants and children older than one month: Clinical features and diagnosis" and "Urinary tract infections in infants older than one month and young children: Acute management, imaging, and prognosis".)


Febrile term infants — In otherwise healthy term neonates, the prevalence of bacteriuria is uncertain. Among neonates and young infants who present with fever, reported rates of UTI vary from 7 to 15 percent [1-3]. In one retrospective study of 670 febrile infants less than 30 days of age who presented to a pediatric emergency department over a 10-year period from 2004 to 2013, 15 percent of patients (n = 100) had a positive urine culture of a specimen obtained by bladder catheterization [1]. Four patients had urosepsis, but there were no deaths or cases of bacterial meningitis.

UTI typically presents in the second or third week after birth in term infants [1]. The incidence of UTI is low (<2 percent) in the first few days of life even in neonates who are bacteremic [4]. As a result, urine cultures are not obtained for term infants who are being evaluated for early-onset sepsis during the first six days of life. (See "Clinical features, evaluation, and diagnosis of sepsis in term and late preterm infants", section on 'Urine culture'.)

Preterm infants — Although data are limited regarding the prevalence of UTI in preterm infants, it appears that the risk increases with decreasing gestational age and birth weight. In one study from an Israeli neonatal intensive care unit from 1990 to 1993, the reported prevalence was 8 percent, but extremely low birth weight (ELBW) infants (BW <1000 g) had a greater risk of 13 percent [5].

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Literature review current through: Nov 2017. | This topic last updated: Sep 12, 2017.
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