ABSTRACT Background: Neonatal sepsis is a major cause of morbidity and mortality worldwide, especially when an infant is delivered preterm. Objectives: The aim of the current work was to evaluate the clinical presentation, etiology, antibiotics use, and mortality in neonatal sepsis cases at King Fahad Medical City. Duration of antibiotics and length of hospital stay were also included. Patients and Methods: This cross sectional retrospective descriptive, single-institute study included a total of 225 neonates suspected to have neonatal sepsis, attending at tertiary hospital, Department of General Pediatric, King Fahad Medical City, Riyadh, Saudi Arabia. This study was conducted between January 2014 to July 2017. Subjects were hospitalized through Emergency Department and included all neonates underage of 28 days.   Results: Among the included 225 neonates, 134 (59.6%) were male and 91 (40.4%) were female. Most of them Term neonates 203 (90.2%). Fever found to be the most common symptoms 184 patients (81.8%) followed by decrease feeding and activity in 124 (55%) and 101 (44.9%) respectively. Respiratory symptoms like cough, tachypnea, runny nose and cyanosis found in 56 (25%). Empirical antibiotics frequently used were amipicillin 209 (92%) and cefotaxime 185 (82%) with median duration of 4days (range 1-47 days). Blood cultures came positive in 8 patients (3.6%). Coagulase negative staphylococci came in 3 (30%) patients and E.coli in 3 (30%) patients as well. Conclusion: It could be concluded that large number of neonates admitted as suspected neonatal sepsis in our hospital resolved their symptoms without find identifiable etiology. In those who had identifiable etiology urinary tract infections (UTI) and viral infections were the common etiology. However, blood stream sepsis and meningitis were quite rare.