Background: Meningitis is the acute inflammation of the meninges, subarachnoid space, and brain vasculature resulting from infection. Regardless of etiology, meningitis in neonates can progress rapidly to serious acute complications. Apart from lab¬oratory tests, cranial sonography is the first modality used in diagnosing neonates and infants with suspected bacterial meningitis and the detection of early and late complications of bacterial meningitis. In our hospital cranial ultrasound (CU) is done for every neonate with a diagnosis of meningitis. In a setup with scarcity of Radiologist and ultrasound machine doing CU for all neonates with meningitis will prolong waiting time to see a radiologist and failed to detect complication timely. Objectives: The objective of this study was to determine the Correlation of cranial ultrasound finding with clinical presentation of complication of neonatal meningitis at Felege Hiwot Comprehensive Specialized Hospital. Methods: A retrospective study that employs document review was conducted in Felege Hiwot Comprehensive Specialized Hospital, neonatal intensive care unit. The correlation of cranial ultrasound finding with clinical presentation of complication of neonatal meningitis was studied. All neonates admitted with a diagnosis of neonatal meningitis and had cranial ultrasound and those who fulfilled the eligibility criteria during the study period of January 1, 2018 to December 30 2018 were the studied. Finally neonates were grouped in to two, as Group I: neonates with no clinical feature of complication and Group II: neonates with clinical evidence of complication. Data were collected by using pretested checklist. Data were collected by trained medical interns with trained General practitioner as a supervisor. Data collected by checklist were entered, cleaned and analyzed using IBM SPSS statistics version 20. Result: A total of 83 neonates with a diagnosis of meningitis and with cranial ultrasound were reviewed. Of these 43(51.8%) were males. The commonest indication for having CU was as a screening (64, 77.1%). From the remaining 19(22.9%) neonates, the most common clinical presentation was increased head circumference (HC) in 11(57.9%) neonates followed by bulged fontanel in 10 (52.6%) neonates. CU was normal in 69 (83.1%) and abnormal in 14 (16.9%) of neonates. The most common complication detected by CU was hydrocephalus 13 (92.8%).Almost all, 13(92.8%) abnormal findings of CU were seen in Group II neonates. The association between indication of CU and CU finding using chi-square was done with p-value of less than 0.05. That is statically significant and the study showed that there was an association between indication of CU and CU findings. Conclusion: Almost all abnormal CU findings were seen in Group II neonates. As the p-value is less than 0.05 and the study showed there was an association between indication of CU and CU finding. The probability of having abnormal CU finding is high in neonates who had signs of complication of meningitis. So, neonates who presented with clinical features of complication of meningitis were more likely to have complication of meningitis and CU should be ordered in these particular neonates. Key words: Cranial ultrasound, neonatal meningitis, complication of meningitis