Objective <p>To investigate the clinical characteristics, diagnostic approaches, treatment strategies, and short-term outcomes of neonatal epididymitis.</p> Methods <p>A retrospective study was conducted of neonates diagnosed with epididymitis at a tertiary referral center between August 2009 and October 2024. Demographic characteristics, clinical manifestations, imaging findings, microbiological results, treatment, and follow-up outcomes were analyzed.</p> Results <p>Thirty neonates were included. The median gestational age was 39 weeks (IQR, 38.00–40.00 weeks), and the mean birth weight was 3.25 ± 0.64 kg. The median age at presentation was 9.5 days (IQR, 6.75–15.00 days). All patients presented with scrotal erythema and swelling, while fever occurred in 30.0% of cases. Right-sided involvement predominated (56.7%). Common local complications included hydrocele (66.7%), orchitis (43.3%), and scrotal abscess (20.0%). Systemic complications included hyperbilirubinemia (16.7%), neonatal pneumonia (13.3%), and sepsis (10.0%). Scrotal ultrasonography established the diagnosis in all patients. Urinalysis was performed in 19 infants, all of whom had normal results. Among 11 patients who underwent culture testing, 4 yielded positive results, including Escherichia coli (<i>n</i> = 2), Kluyvera ascorbata (<i>n</i> = 1), and <i>Salmonella Hillingdon</i>. (<i>n</i> = 1). Four infants underwent incision and drainage because of abscess formation. During follow-up (median, 13 months), no obvious testicular atrophy or recurrence was observed.</p> Conclusion <p>Neonatal epididymitis is a rare condition often associated with local complications such as orchitis and hydrocele, as well as systemic infections. A normal urinalysis does not exclude the diagnosis. Early ultrasonography plays a crucial role for differentiating epididymitis from testicular torsion and may help avoid unnecessary surgical exploration.</p>