Background: Neonatal Due to its complicated aetiology and varying clinical manifestations, acute kidney injury (AKI) presents substantial problems in diagnosis and therapy. The absence of established diagnostic criteria and the vast variety of predisposing variables further hinder the understanding and prompt action for this disorder. The purpose of this review is to shed light on the complex nature of neonatal acute kidney injury (AKI), including its definition, epidemiology, clinical phenotypes, risk factors, evaluation, management strategies, and the potential role of scoring systems, with a particular emphasis on the STARZ score. Conclusions: Neonatal AKI originates as a complicated entity impacted by numerous prenatal and postnatal causes. The research highlights the critical need for standardised diagnostic criteria as well as the need of a holistic approach to diagnosis. It also draws attention to the changing landscape of management techniques and the promise of prognostic and therapy guidance scoring systems like STARZ for this at-risk group.