Patients in the neonatal intensive care unit (NICU) are at risk for morbidity and mortality not only from their critical illness but also from secondary processes such as nosocomial infections. Ventilator associated pneumonia is a common and severe complication of critical illness .it is associated with increased hospital and intensive care unit length of stay and high morbidity and mortality in NICU. The objectives of this work were to determine the incidence of occurrence of ventilator associated pneumonia (VAP) in NICU in Abu El-Reish Children Hospital, Cairo University and to detect the most common etiological pathogen. In this study (90) neonates were included, (55.6%) were males and (44.4 %) were females. The gestational age ranged from 27 weeks to 40 weeks with median of 34 weeks and their birth weight ranged from (0.85 kg) to (4.5 kg) with median of (2) kg. The commonest admission diagnosis was respiratory distress syndrome (55.6%), complication was observed in (54, 4%) of cases. The incidence of ventilator associated pneumonia in this study was 41.9% of the studied patients and diagnosis depends on endotracheal aspirate culture result. Neonates with ventilator associated pneumonia (VAP) had longer length of stay in NICU and longer duration of mechanical ventilation. Gram negative organisms were the major cause of VAP in the study and Klebsiella pneumoniae was the predominant isolate (65.9%). Outcomes of neonates with VAP was (71.4%) died and( 29.1%) discharged. mortality was observed more with lower birth weight ,smaller gestational age , longer length of stay in NICU and duration of mechanical ventilation.