Patients in the intensive care unit (ICU) are at risk for mortality not only from theircritical illness but also from secondary processes such as nosocomial infection. Ventilator associated pneumonia is a common and severe complication of criticalillness. It is associated with increased hospital and intensive care unit length of stay and highmorbidity and mortality rate in ICU patients. The objectives of this work were to determine the incidence of occurrence of ventilatorassociated pneumonia in Neonatal Intensive Care Unit in Abu El-Reish children's hospital,Cairo University, and to detect the most common etiological pathogens. In this study 162 neonates were included , 61.1% were males and 38.9% were females.The gestational age ranged from 26 weeks to 41 weeks with median of 38 weeks, and theirbirth weight ranged from 0.78 kg to 4 kg with median of 2.35 kg. The commonest admission diagnosis was respiratory distress syndrome (50.6%),Complications were observed in 30.2% of cases. The incidence of ventilator associated pneumonia in this study was 41.9% of thestudied patients and the diagnosis depends on the endotracheal aspirate culture result. Neonates with VAP had longer length of stay in NICU and longer duration ofmechanical ventilation. Gram-negative organisms (88.3%) were the major cause of VAP in thestudy and Klebsiella pneumoniae was the predominant isolate. 29.4% of patients withventilator associated pneumonia showed associated bacteremia. Outcome of neonates with VAP was 51.5% died and 48.5% discharged. Mortality wasobserved more with lower birth weight, smaller gestational age, longer length of stay in NICUand duration of mechanical ventilation, and occurrence of intracranial haemorrhage. VAPcaused by Klebsiella pneumoniae had a higher rate of mortality.