Background: Due to various problems, theneonatal period is one of the most vulnerable periods of life. Despite many advances in perinatal and neonatal care, neonatal mortality is still very high in developing countries. This study was undertaken to study the disease pattern and outcome of neonates admitted to the sick neonatal intensive care unit (SNCU) of tertiary care hospital of Shimla district of Himachal Pradesh, India. Methods: Retrospective review of medical records of alloutborn neonates admitted to the Specialized Neonatal Care Unit of pediatric ward of IGMC (Indira Gandhi medical colleges), Shimla covering the period from January 2016 to December 2020 was conducted. The most important causes of mortality and its associatedfactors were analyzed. Results: A total of 4018 outbornneonates were admitted in the SNCU of IGMC Shimla in 5 years from Jan 2016 to Dec 2020.Among them 3034 (75.51%) were discharged after recovery, 305 (7.59%) were referred to higher institution, 372(7.90%) left against medical advice and 307(7.64%) died in SNCU. Among the total of 307 neonatal deaths,maximum 110(35.83%) were due to sepsis/Pneumonia/Meningitis, followed by 60(19.54%) due to respiratory distress syndrome,50(16.29%) due to HIE/Moderate-severe Birth Asphyxia, 36(11.73%) due to other causes, 24(7.84%) due to prematurity, 13(4.23%) due to un-established causes, 12(3.91%) due to Meconium aspiration syndrome, and 2(0.65%) due to major congenital malformation. Maximum neonate 118(38.44%) had weight between 1500-2499 gm, 102(33.22%) had >2500gm, 71(23.13%) had between 1000-1499 gm while 16(5.21%) had weight <1000gm. Among the total of 307 neonatal death, 131(42.67%) were preterm while 176(57.33%) were having term birth. Conclusion: Sepsis, birth asphyxia and RDS are important preventable causes of mortality, which must be urgently addressed, if India hopes to achieve itsSustainable Development Goals.