Background: Neonatal ventilator associated pneumonia (VAP) is a major hospital-acquired infection in acute care settings, associated with high mortality and poor outcome. Objectives: The purpose of this study is to evaluate the frequency of ventilator associated pneumonia, its causative organisms, its risk factors and outcomes at our NICU. Methods: This is a prospective observational cohort study used Centers for Disease Control (CDC) guidelines for infant's ≤1 year old to diagnose neonatal VAP. All inborn and out-borne neonates who admitted to our NICU from April 2018 to March 2019 were screened for study enrollment and were considered eligible if ventilated for more than 48 hours. They were classified into: Group A: cases with suspected VAP and Group B: cases without VAP. Results: Thirty eight out of 140 patients admitted to NICU were VAP with frequency 27.2%. There were significant changes in the vital signs, respiratory manifestation, ventilator settings, radiologic progression and laboratory findings in VAP group.  The risk factors were birth weight less than 1500g (P=0.002), prematurity (P< 0.05), duration of ventilation (26.0 ± 11.5 days, P<0.001) and duration of hospital stay (40.3±14.9). Microorganisms associated with bloodstream infection in the VAP-diagnosed group were Klebsiella spp., Staphylococcus aureus, Candida spp. and other Gram negative bacilli (26.3, 5.2, 31.5, and 15.7% respectively). Klebsiella spp. was the most commonly isolated pathogen in non-bronchoscopic bronchoalveolar lavage. In-hospital mortality rates in VAP and non-VAP groups were 65% and 25.5% respectively (P<0.001). Conclusions: The frequency of ventilator acquired pneumonia (VAP) in NICU was 27.2%. The most common risk factors of VAP were very low birth weights, prematurity, longer duration of ventilation and duration of hospital stay while Klebsiella spp. was the most common microorganism associated with bloodstream infection.