Background: Neonatal sepsis remains a challenge for neonatal care providers.Aim: This work was aiming to measure red cell distribution width percent (RDW %) as a marker for neonatal sepsis and to correlate it with other indicators and with a simple clinical scoring system for neonatal sepsis (Griffin score).Methods: This case control study was carried out at neonatal intensive care unit at Fayoum University Hospital and Abshawai central hospital . Ethical Research Committee Approval and written consents were obtained from parents of the neonates30 neonatal sepsis cases and 30 normal controls. Neonates were subjected to: History taking, clinical examination for manifestations of sepsis. Complete blood count, differential leucocytic count, C-reactive protein, Blood culture, RBS, and determination of RDW % were done to all neonates.Results: Our study showed that I/T ratio and RBS was significantly higher in cases than controls (p<0.001), but WBCs show no statistically significant difference among cases and controls. Moreover, blood culture was positive in 63.3% of cases only. Also, CRP was high in 76.7% of cases and 30% of controls (P=0.01) , and that the mean RDW % was higher among cases than controls (16.4 ± 3.8 and 13.7± 1.6 respectively) (P = 0.001), with further increase in preterm neonates . Also, there was a significant positive correlation between RDW level Griffin score (p=0.001). However, there was insignificant difference between RDW and WBCs or I/T ratio but high RDW level associated with raised RBS level of study group. Conclusion:RDW can serve as a marker and prognostic indicator in neonatal sepsis especially when used together with Griffin score.

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