Introduction: Even though reduction of neonatal mortality is needed to achieve Sustainable Development Goals 2030, advanced maternal age is still an independent and a substantial risk factor for different adverse perinatal outcomes, responsible for neonatal morbidity and mortality. In Ethiopia, researches have validated that advanced maternal age is a significant factor for neonatal morbidity and mortality, but studies which addressed or estimated those adverse neonatal outcomes are limited and specifically no study was done in the study area. Objective: To compare adverse neonatal outcomes and its associated factors among women with adult and advanced aged pregnancy at Awi Zone, Northwest Ethiopia 2020. Methodology: comparative cross-sectional study was conducted in Awi Zone public hospitals, Northwest Ethiopia from February 25 to March 25/2020. Systematic random sampling was employed to select 524 (348 adults and 176 advanced age) women. Interview and chart review based structured questionnaires were applied to collect the data. The collected data were analyzed using Statistical Package of Social Sciences version-25. Binary and multivariable logistic regressions were fitted to assess the association between adverse neonatal outcomes and explanatory variables. P-value less than 0.05 was used to declare final statistical significance. Result: a total of 520 mothers who gave birth were included, giving a response rate of 99.2%. The prevalence of adverse neonatal outcome among advanced aged women (29.1%) was higher compared to adult aged women (14.5%). The odds of adverse neonatal outcome was higher among advanced aged women when compared to adult aged women (AOR=2.01, 95% CI: 1.06, 3.79). No formal education (AOR=2.75, 95% CI: 1.27, 5.95), short birth interval (AOR=2.25, 95% CI: 1.07, 4.73) and complications during pregnancy (AOR=2.12, 95% CI: 1.10, 4.10) were also significantly associated with adverse neonatal outcomes. Conclusion and recommendation: composite adverse neonatal outcomes, low birth weight, prterm birth and low 1st minute Apgar score were significantly higher among advanced aged compared to adult aged women. Advanced maternal age, no formal education, short birth interval and complications during pregnancy were significantly associated with adverse neonatal outcomes. Access of equal education, provision of family planning and perinatal care (early detection and management of complications) is recommended. Key words: adverse neonatal outcomes; advanced maternal age pregnancy; Ethiopia.