Background: Neonatal thrombocytopenia (platelet count < 1.5 lac/µl) is the commonest haematological abnormality encountered in neonatal intensive care unit (NICU). Thrombocytopenia if not detected can result in devastating complications. Determining the risk factors of thrombocytopenia enables us to prevent the inevitable and irreversible complications. The present study highlights the pattern, severity and risk factors of neonatal thrombocytopenia in our hospital.Methods: Prospective observational study was conducted on 200 neonates with thrombocytopenia admitted in NICU of our hospital. Maternal and neonatal risk factors were recorded. Neonates were grouped based on the severity of thrombocytopenia. The risk factors were compared with severity of thrombocytopenia.Results: 200 neonates with thrombocytopenia were divided into three groups based on severity of thrombocytopenia. 81% of babies had moderate to severe thrombocytopenia. The most common maternal predisposing factors were pregnancy induced hypertension (PIH), premature rupture of membranes (PROM) and anemia.62.5% babies were low birth weight babies and they had severe thrombocytopenia. 56% babies had late onset neonatal thrombocytopenia and 44% had early onset thrombocytopenia. The most common neonatal risk factors were sepsis in 48.5% babies and birth asphyxia in 20% babies.Conclusions: The severity of neonatal thrombocytopenia in our NICU was moderate to severe type. PIH, PROM and anemia were the commonest maternal risk factors. Preterm and low birth weight babies had severe thrombocytopenia. Sepsis and birth asphyxia were the commonest neonatal risk factors. Birth asphyxia was associated with early onset neonatal thrombocytopenia and sepsis was associated with late onset thrombocytopenia. Severe thrombocytopenia can be used as a prognostic indicator in sick neonates.