BackgroundNeonatal near miss refers to a condition where a newborn is close to death within the first 28 days of life but ultimately survives either by chance or because of the quality of care they received. It is considered a major public health problem that contributes to the global burden of disease in less developing countries. For every death due to NMM, many others develop a severe complication. Despite this grim reality, there seems to be a gap in terms of the magnitude of and predictors of NNM in Ethiopia, where the previous study focused on neonatal death investigation. This study aimed to determine the magnitude of NNM and its determinants among the neonates delivered in the North Shewa zone, Central Ethiopia.MethodsA facility-based cross-sectional study was conducted using a systematic random sampling technique among 747 newly delivered babies in the North Shewa zone public hospital from January 30 to June 30, 2021. Neonatal near misses were identified with the help of the World Health Organization labeling criteria. Collected data were coded, entered, and cleaned by using Epi data 4.4.6 and analyzed using SPSS software (version 26) for analysis. Descriptive statistics were used to compute summary statistics and proportions. Variables at a cutoff value of 0.25 on bivariate and 0.05 on multivariate logistic regression were used to identify predictors.ResultThe prevalence of NNM was 35.3% (95% CI = 31.9–38.6) per 1,000 live births. Participant occupation [AOR: 0.55, CI: 0.33–0.90], marital status [AOR: 2.19; CI: 1.06–4.51], instrumental delivery [AOR: 1.98; CI: 1.10–3.55], intrapartum hemorrhage [AOR: 2.27; CI: 1.03–5.01], abortion history [AOR: 1.59; CI: 1.03–2.44], mal-presentation [AOR: 1.77; CI: 1.14–2.77], premature rupture of membrane [AOR: 2.36; CI: 1.59–3.51], and pregnancy-related infection [AOR: 1.99; CI: 1.14–3.46] were found to have statistically significant association.Conclusion and recommendationOne-third of neonates face serious neonatal health conditions. Given this, addressing modifiable obstetric risk factors through providing skilled and quality care to mothers during pregnancy and during and after childbirth was important for improving neonatal health. Additionally, strengthening antenatal care services to minimize the infection occurring during pregnancy through the provision of appropriate services and counseling about the consequences of abortion was essential in reversing the problem.