Assessing neonates and children younger than 3 months with suspected UTI

Refer neonates and children younger than 3 months with suspected urinary tract infection (UTI) for assessment by a clinician with appropriate training and experience at a location equipped to manage their care.

Clinical features of UTI in neonates and children younger than 3 months, are usually nonspecific and may include fever, being unsettled (eg irritable) and not tolerating oral feeds. Urinalysis can be unreliable in this age group; nitrites and leucocyte esterase may be negative.

Recognising sepsis in neonates and children younger than 3 months is challenging because signs of sepsis may be subtle and often include clinical features that are similar to other infections, including UTI – see Approach to assessing sepsis or septic shock in neonates and children. Always consider meningitis in neonates and children younger than 3 months who present with fever, because classical signs observed in older children and adults are often absent.

Note: Signs of sepsis may be subtle in neonates and children younger than 3 months; meningitis must be considered because classical signs are often absent.

Consider maternal history of colonisation or infection with multidrug-resistant gram-negative bacteria (eg Escherichia coli strains producing extended-spectrum beta-lactamases [ESBLs]; see Risk factors for infection with a multidrug-resistant gram-negative bacterium for risk factors) because this may alter empirical antibiotic choice.