Background: Neonatal near-miss refers to situations in which babies are on the verge of dying in the neonatal period of life due to severe morbidity but survive either by luck or due to quality of health care recieved. Every year, four million newborn babies die in the first month of life in low and middle-income countries. Identifying cases and addressing their determinants is crucial for comprehensive and relevant interventions to tackle neonatal morbidity and mortality. There was little evidence on determinants of neonatal near miss in the study area. Objective: To identify determinants of neonatal near misses among neonates admitted at Tibebe Ghion specialized hospitals,Bahir dar, Ethiopia, 2022. Methods: Hospital-based unmatched case-control study design was conducted. This study was recruited 106 cases sequentially and 210 controls by systematic random technique. The data was collected by using a structured interviewer-administered questionnaire with supplementation of maternal and neonatal medical records with checklists. Data were coded, cleaned and entered into Epi data version 3.1 and then exported to the Statistical Package for Social Science version 25 for analysis. The descriptive statistics run and the results of the data were presented using frequencies, percentages, texts, and tables. Both bivariable and multivariable logistic regression were computed at 95%CI and the final model was checked by Hosmer and Lemeshow goodness fit. Multi collinearity and confounders were checked. Results: Multivariate analysis showed that No ante natal care follow-up (AOR=6.35, 95%CI: 2.49-16.13), Mothers who were planned current pregnancy (AOR=0.271, 95%CI: 0.12–0.61), premature rupture of membrane(AOR=2.62, 95%CI: 1.33–5.19), preeclampsia (AOR= 6.55, 95% CI:1.72-6.95) and anemia during pregnancy (AOR=3.45, 95%CI: 1.64–7.24) were significant determinants of neonatal near-miss. Conclusion: Ante natal care follow-up, current pregnancy type, premature rupture of membrane, preeclampsia, and anemia during pregnancy were significant determinants of neonatal near-miss, Therefore, much work is needed to improve neonatal health by providing adequate Antenatal care services, health education, training and make collaboration with different stockholders. Keywords: Bahir Dar, Determinant, Neonatal near miss, Tibebe Ghion Specialized Hospital