Background: Neonatal period is a vulnerable time in which the newborn has to adapt to a totally new environment and is susceptible to many problems, which may even be life threatening. It is found that neonatal mortality rate is decreasing in Nepal but at a slower pace than infant and child mortality. In order to improve neonatal outcome, it is crucial to identify the areas where health care can be improved. Objectives: This study was conducted to analyze the spectrum of diseases and outcomes at a level two NICU at a tertiary care teaching hospital. Methods: A descriptive observational study conducted at the neonatal care unit in the Department of Paediatrics at KIST Medical College, Lalitpur, Nepal over one year from 14th of April 2013 to 13th April 2014. Data on age at admission, gender, gestational age, birth weight, initial presenting symptoms at admission, ? nal diagnosis and outcome were collected from in patient records at the hospital record section and analyzed using SPSS 17.0. Results: A total of 279 neonates were studied. The commonest causes of admission were infection (45.9%), followed by respiratory conditions (14.7%), neonatal jaundice (12.5%), perinatal asphyxia (9.3%) and prematurity/ small for gestational age (SGA) (6.5 %). Most of the admissions (62%) were during the ? rst 24 hours of life. The majorities, 89.2%, were term gestation and 10.8% were preterm. Most of the preterm babies were late preterms with gestational ages between 3536 weeks (73% of preterms were late preterms). Total of four mortalities (1.4%) occurred, three of which were due to perinatal asphyxia and one was a Down’s syndrome with overwhelming sepsis. Conclusion: In this study, infections followed by respiratory conditions were the leading causes of admission. Most of the admissions occurred during the ? rst 24 hours of life. This emphasizes the fact that attentiveness during the ? rst day of life, simple measure to prevent infection and early detection and treatment may go a long way in improving neonatal outcome.