Background: Low birth weight (LBW) babies frequently have hyperglycemia, which is linked to greater mortality as well as morbidity. The threshold intervention and management protocols are controversial. Objectives: To define the incidence of neonatal hyperglycemia, associated risk factors, and the outcome in LBW infants in tertiary Neonatal Intensive Care Units in Ain Shams University, Cairo, Egypt. Patients and Methods: In a prospective observational trial, 125 low birth weight neonates were included in this study. Blood glucose concentration was monitored daily in all infants for 7 days. Insulin therapy was initiated if hyperglycemia >200 mg/dL despite reductions in glucose infusion rate. Outcomes were reported till 28 days of life. Results: Twenty-four percent of the cohort developed hyperglycemia. Mortality and intraventricular haemorrhage (IVH) were significant outcomes and higher in the hyperglycemia group compared to euglycemia group. This could be related to the higher glucose levels and not to the duration of hyperglycemia. Twenty-three infant (76.7%) among the hyperglycemia group responded to decreasing glucose infusion rate (GIR) while 7 infants (23.3%) needed insulin; 3 (42.9%) improved, 4 (57.1%) had hypoglycemia attacks and died. Conclusions:Among low birth weight infants' hyperglycemia was associated with morbidity and death. Using insulin as a line of treatment for hyperglycemia may be associated with hypoglycemic attacks and mortality.