Background: Very low birth weight (VLBW) neonates are at high risk for morbidity and mortality. Preterm birth is one of the major clinical problems in Obstetrics and Neonatology. Aim & Objective: To study morbidity and mortality pattern of VLBW neonates admitted to NICU at Department of Pediatrics, Civil hospital, Ahmedabad. Methodology: This cross-sectional prospective observational study was performed on all hospitalized VLBW neonates. Their course during hospitalization and relevant was documented in pre designed performa. Results: In the present study, out of 1748 neonates, 374 (21.39%) were VLBW with 69% males. Mean gestational age was 31.3±1.8 weeks; mean birth weight 1279±193 grams. Common morbidities in VLBW neonates are Neonatal jaundice, Probable sepsis, Apnea of prematurity and RDS. Mortality rate is improved with increasing gestational age and weight. Conclusion: Birth weight and mechanical ventilation are the 2 major factors responsible for mortality. A decline in the mortality and morbidity of these newborns (especially the ELBW neonates) can only be made possible through optimizing perinatal care including regionalization, CPR at birth, early NCPAP and quality improved collaborative (QIC) in our NICU.