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Neonatal sepsis is common; particularly in preterm babies. However, it is uncommon for neonatal sepsis to present as localized liver abscess. Since 1930, less than 150 cases of liver abscess have been reported in the literature. The majority of initially reported cases were in term babies; while over the past two decades an increasing incidence in preterm babies has been reported. This is most likely due to increasing survival of preterm babies and associated increased use of invasive procedures (umbilical venous catheterization, and central venous lines) and the use of total parenteral nutrition. Apart from high index of clinical suspicion, an ultrasound (US) scan and computed tomography (CT) of the abdomen are required to confirm the diagnosis of liver abscess in a sick newborn baby.