Background: Neonatal Acute Kidney Injury (AKI) is a critical concern in neonatal intensive care units (NICUs), impacting morbidity and mortality. Early identification of AKI and its risk factors is crucial for improved neonatal care. This study aimed to identify the incidence, predisposing factors, clinical features of AKI in neonates admitted in NICU. Methods: A total of 200 neonates out of 570 cases attending the outpatient clinic were enrolled in the study. Clinical information, maternal medical history, examination findings, laboratory parameters, and medication exposures were collected and analyzed. The KDIGO workgroup definition was adapted to define neonatal AKI. Results: Among neonates, 45.0% developed AKI. Gender and gestational age showed no significant differences between AKI and non-AKI groups. Birth weight below 1000g was associated with AKI (p = 0.03). Neonates with AKI were more likely to receive aminoglycosides and vancomycin (p < 0.001), exhibit oliguric urine output (p < 0.001), and have hypertensive blood pressure levels (p < 0.001). Higher CRP levels (p = 0.002), total leukocyte count (TLC) (p = 0.002), and hemoglobin levels (p = 0.04) were observed in the AKI group. Additionally, sodium and potassium imbalances (p < 0.001) and metabolic acidosis (p < 0.001) were prevalent in AKI cases. Conclusion: This study showed the effect of birth weight, medication exposure, and clinical markers on AKI development. Elevated C-reactive protein levels and blood parameter imbalances serve as important risk indicators.