Background: Introducing multimedia technologies in learning in many universities has been observed as means of improving accessibility and quality of delivery and learning among the students. Aim: This study aimed to compare the effect of e-learning strategy versus traditional learning on pediatric nursing students' knowledge, engagement, and clinical performance regarding neonatal endotracheal suction during COVID 19 Pandemic. Design: A comparative quasi-experimental design was carried out. Subjects: A convenient sample of 120 pediatric nursing students, who selected from the pediatric nursing course during the first semester of academic year 2020-2021 were randomly assigned into two equal groups. Setting: Faculty of Nursing, Matrouh University, E- learning group taught through the university official Microsoft teams' platform. While, traditional learning group taught in pediatric nursing laboratory. Tools: three tools were used; Tool I: Pediatric Nursing Students` Knowledge Concerning Neonatal Endotracheal Suction Questionnaire, Tool II: Neonatal Endotracheal Suction Performance Observational Check List, Tool III: Pediatric Nursing Students' Engagement Scale.  Results: The mean participants' knowledge in e-learning group was 5.25+ 1.310, 11.20+1.867, 12.48+0.771 and 10.28+0.585 compared to 6.68+ 1.642, 12.60+1.330, 13.48+0.725 and 10.28+0.585 for traditional group all over the periods of the study. Students who received e-learning learning retained more skills all over the periods of the study (21.13+2.046, 47.88+9.620, 50.57+2.396, and 51.05+2.459) compared to traditional learning (21.13+2.046, 47.88+9.620, 39.60+10.791, 40.87+11.465 and 38.55+4.260).  Students of traditional group more engaged than those of e-learning group all over the periods of the study 64.8833+4.57366 compared to 65.4500+ 4.20018. Conclusion: Expending traditional strategy through face to face interaction was effective in improving students' knowledge retention, while e-learning group retained more skill than those of traditional group. Recommendation:  it was recommended to conduct more studies to confirm the impact of adopting both E-learning and traditional strategies in accelerating the efficacy of knowledge and skills retention for students, as well as improving their engagement.