A urinary tract infection (UTI) is one of the most common bacterial infections diagnosed in childhood. This condition should be given strong consideration in the differential list when evaluating the febrile, ill neonate. The diagnosis of a UTI can lead to significant morbidity for the child, not only from the disease process itself but also from the formidable diagnostic evaluation subsequent to initial presentation. Given the premature immune system, infants, and particularly neonates, are at risk for disseminated bacteremia, which can lead to a more dangerous scenario than in older children and adults. Due to this associated danger, a thorough evaluation and prompt treatment when necessary are mandatory. In addition, the pediatric specialist needs to recognize that UTI may be a marker of a more serious, underlying urologic congenital and/or functional anomaly, which may be amenable to operative correction.