Background; Neonatal intestinal obstruction is the most common surgical emergency in a newborn requiring prompt intervention. Objective; This study aims to asses operative outcome and associated factors of neonatal intestinal obstruction. Methods; This study was done retrospectively to include all operated cases of neonatal intestinal obstruction from FHSH from (sep 1,2007 to Jan1,2011) and TGSH from (Jan1,2011 to aug 2014) EC and various factors affecting outcome will be analysed. A structured research tool used to collect all the necessary data from the patients’ medical records. Data analyzed by using SPSS version 25 Frequencies with percentages used to describe the surgical management outcome of NIO. Binary logistic regression model used to explore the determinant factors associated with the surgical management outcome of NIO. Factors at P value < 0.05 declared statistically significant. Result : During the study period ,175 neonates operated for neonatal intestinal obstruction. Birth weight <2.5kg had significant association for neonatal intestinal obstruction (p=0.000) and adjusted odds ratio (AOR) of 71.859 and 95% CI (8.693,594.033). Intestinal anastomosis was also significantly associated with neonatal intestinal obstruction with(p=0.013) AOR=3.104 and 95% CI (1.204,8.706). Duration of illness before operation (in days) was also significantly associated with intestinal obstruction (p=0.020), AOR=3.238 and CI (1.204,8.706) Conclusion : The study identified that longer duration of illness(>3days), low birth weight were significantly relate with unfavorable outcomes. The overall survival rate of newborns operated for NIO was found to be 83.4% and sepsis was the leading postoperative complication resulting death. Kay words: Neonatal Intestinal obstruction, Etiology, operative outcome