Sepsis is a common complication in the NICU. The incidence ofneonatal sepsis is 1-5/1000 live birth and its mortality rate is 5-20%.Mechanical ventilation plays an important role because artificial airwaysbypass the body's defense against inhaled pathogens and offer new routesfor non-airborne pathogens.The goal of our work is to clarify the valuable comparison ofendotracheal aspirate cultures versus blood cultures in order to predictsepsis in ventilated preterm and full term neonates, 60 full term ( ≥ 37wks ) and preterm (< 37 wks ) neonates. And with respiratory distress andmechanically ventilated in NICU with clinical evidence of sepsis wereselected for our study. Our selected cases were subjected to clinicalevaluation and to the Hematological Scoring System of Sepsis. Thegolden pearl in our study is the blood culture for any neonatal infantsuggested clinically and by laboratory criteria to be neonatal sepsis.We found that Endotracheal aspirate culture is not considered agold standard as sensitivity and specificity in predicting sepsis inventilated newborns is low in comparison to blood culture results, the rateof culture positivity increased as the birth weight decreased, gestationweek got smaller and the duration of intubation prolonged.