Background: Neonatal tetanus is a deadly infection leading to 7-8% of neonatal mortality in de-veloping countries. WHO defines Neonatal tetanus as an illness in a child who has the normal ability to suck in the first 2 days of life, presented with failure to suck between 3rd and 28th days of life and has rigidity and spasms? Though Ethiopia declared maternal and neonatal tetanus elimination in 2017, there has been significant number of neonates presenting with this problem in Neonatal ICU’sMethods: This review characterized clinical profile, demography and outcome of seven neona-tal tetanus cases admitted at Dilla University hospital, neonatal ICU from September 11, 2018 to September11, 2020.Results: All mothers gave birth at home with unskilled birth attendant, local blade or knife was used to cut the cord. Median age for mothers was 26 years and two out of seven had antenatal care (ANC) follow up and took Two doses of tetanus toxoid (TT) vaccine. Fever, failure to suck, spasm and convulsions were the common presenting symptoms. The overall mortality was 70%.Conclusion: Continuous emphasis on antenatal tetanus immunization and safe delivery practic-es should be maintained. Clinicians caring for neonates should be aware of the presentations of neonatal tetanus to allow them to diagnose these patients early and initiate appropriate lifesaving management.