Neonatal thrombocytopenia is one of the most common hematological problems encountered in the NICU. We designed a study to determine the frequency, etiological profile, predisposing factors of thrombocytopenia in our NICU. The clinical impact of thrombocytopenia and its influence on the neonate's outcome were also studied. Methods: 179 consecutive NICU admissions in a 6 month period were included in our study. The subjects were grouped into 3 cohorts based on their platelet counts and their association with various variables was studied. The efficacy of the treatment protocol practiced for thrombocytopenia was evaluated. The neonates were followed up over a period of 6 months. To assess the prognostic value of severe thrombocytopenia; 12 variables that were significantly associated with poor outcome in the univariate analysis including low platelet count, along with other variables that are known to be associated with a poor outcome in NICU graduates, were subjected to multiple logistic regression using SPSS 13.0. Results: The prevalence of thrombocytopenia in our NICU was 39%. Septicemia was the common etiology. Maternal PIH, age at presentation, NEC, DIC, candiduria and assisted ventilation were identified as the predisposing factors. Severe thrombocytopenia was independently associated with a poor outcome based on multiple logistic regressions. Conclusion: Neonatal thrombocytopenia is far more common in our NICU as compared to that of the western studies. Septicemia is the most common cause. There are various predisposing factors for neonatal thrombocytopenia. Severe thrombocytopenic neonates are more likely to bleed and have a prolonged clinical course. Severe thrombocytopenia can be used as a prognostic indicator in sick NICU graduates. Fresh whole blood transfusion is a good alternative to platelet concentrates in the treatment of severe thrombocytopenia