Abstract Background: Necrotizing enterocolitis is a leading cause of death among patients in the neonatal intensive care unit, carrying a mortality rate of 15–30%. Its pathogenesis is multifactorial and involves an overreactive response of the immune system to an insult. Therefore, understanding the prevalence and associated factors of necrotizing enterocolitis in preterm neonates is essential for developing targeted prevention strategies. Objective: To assess prevalence and associated factors of necrotizing enterocolitis among Preterm neonates admitted to the neonatal intensive care unit at TibebeGhion Specialized Hospital, BahirDar, Ethiopia. Method: An institution-based cross-sectional study was conducted from June, 02 to December, 30, 2025, at the NICU of TibebeGhion Specialized Hospital, Bahir Dar, Ethiopia. A total of 234 Preterm neonates (GA < 37 weeks) were selected using a systematic random sampling. technique. Data were collected by reviewing the patients’ cards. Data were cleaned, coded, and entered into Epi-Data and exported to SPSS for analysis. Descriptive statistics like frequency, and percentage was used to describe the characteristics of participants. The results were presented using tables, graphs, and charts. Bivariable and multivariable logistic regression analyses performed to identify associated factors. The goodness-of-fit test was checked by Hosmer. and the lemeshow test (p=0.116) as well as the absence of multicollinearity was checked by VIF and a A cuff-off point of 10 was used to declare the absence of multicollinearity between independent factors. Result: The prevalence of necrotizing enterocolitis among preterm neonates admitted to NICU was 13.42% (95% CI: 9.57, 18.49). Gestational age (AOR = 5.59, 95% CI: 1.45, 21.46), birth weight (AOR = 7.96, 95% CI (1.29, 49.28), APGAR score (AOR = 31, 95% CI (.11, .89), PROM (AOR = 4.29, 95% CI (1.40, 13.16), duration of hospital stays (AOR = 6.16, 95% CI (1.45, 26.12) were found to be statistically significant factors associated with necrotizing enterocolitis prevention practice. Conclusion: This study found that the prevalence of NEC among preterm neonates admitted to NICU was high. Multifaceted clinical services targeted, PROM, hospital stay, low birth weight, and gestational age could tackle this problem.