Various hepatic and biliary disorders could be met with in neonatal intensive care units. They should be detected early and evaluated promptly. This study was planned to detect the occurrence of hepatic insult affection and its potential risk factors that can jeopardize babies admitted to NICU. The study was carried on all babies admitted the NICU of New Children's Hospital of Cairo University from April to October 1999. It included 100 cases with various causes of admission. Nine cases (9%) showed hepatic affection both by laboratory studies and imaging techniques, seven cases had neonatal sepsis (5 community acquired and 2 nosocomial) while the other 2 cases had congenital rubella and congenital CMV. Five cases died from various problems not including hepatic failure (60%), while 4 cases recovered completely (40%). We conclude that sepsis is a major risk in the appearance of hepatic insult in NICU babies. Therefore all measures to prevent, early diagnosis and aggressively manage neonatal sepsis should be followed. On the other hand, close observation of liver status in case of neonatal sepsis is recommended in order to detect early affection and avoid other hepatic toxic risk factors in such situations.