Background: Early onset pneumonia could be caused by bacteria, virus or fungi. Early identification and treatment with antibiotics is vital in reducing mortality and morbidity. Objectives: The current study aimed for detection of organisms that cause early onset pneumonia guided by nasopharyngeal aspirate culturing, in addition to blood culturing. Patients and methods: This study was applied on 36 neonates admitted to NICU in Zagazig University Children Hospital, during the period from October 2018 to April 2019. Results: There was no relation between gestational age and birth weight with neonatal pneumonia (NP) incidence rates. The prevalence of confirmed early onset NP with positive blood culture was 88.9%. The hospital stays of studied subjects were 7.2 ± 3.5 days. Neonatal pneumonia caused by Gram negative bacteria (53.1%) was more common than Gram positive bacteria (46.9%). K. pneumonia (37.5%) was the most common microorganism isolated from the blood cultures. S. saprophyticus (21.8%) was the most frequently recovered CONS isolate from blood cultures, followed by S. cohnii (9.4%) and S. haemolyticus (6.3%). The most prevalent organism isolated from BAL fluid was Klebsiella (38.5%). Conclusion: Neonatal sepsis remains a major problem in neonates. Gram-negative bacteria were the most common cause of early onset NP in Zagazig University Hospital with K. pneumonia being the most common pathogen. Regular periodic surveillance of the causative organisms of neonatal pneumonia is needed to implement the rational empirical choice of antibiotic prescription while waiting for blood culture result to come out.