Infants prenatally exposed to cocaine are reported to have an increased incidence of genitourinary tract abnormalities. Because children with genitourinary tract anomalies have a higher incidence of urinary tract infections, a prospective study was performed to investigate the incidence of urinary tract infections in cocaine-exposed infants. The urine culture results were positive in 14% of 110 cocaine-exposed infants studied. This is significantly higher than the 4% infection rate in our control group and higher than the previously reported incidence of 0.1% to 3% urinary tract infections in newborns. Although the incidence of abnormal results from renal ultrasonography was high (16%), abnormal results did not correlate with the development of a urinary tract infection. Other laboratory tests also did not predict urine culture abnormalities. Urine culture screening is recommended for all cocaine-exposed infants.