This study aimed to evaluate neonatal near miss (NNM) in a state in northeastern Brazil and to identify possible sociodemographic, obstetric, childbirth, and healthcare-related determinants. This cohort study of live births was conducted from 2012 to 2020 in Bahia, Brazil (n = 1,821,384), using data retrieved from national health information systems (Live Birth Information System and Mortality Information System). The criteria for defining NNM were gestational age < 32 weeks, birth weight <1,500 grams, 5-minute Apgar score <7, and congenital malformations. Logistic regression models with hierarchical entry of variables were adjusted, and the odds ratio was estimated with 95% confidence intervals. The NNM rate was 30.4/1,000 LB. The following risk factors for NNM were identified: newborn sex (male); maternal age (10–19 years and 35 years or older); low maternal schooling; not having a partner; having one or more fetal losses/miscarriages; multiple pregnancies; having had fewer than six prenatal care appointments; absence of labor induction; having had a cesarean section and non-cephalic fetal presentation. The protective factors for NNM were being primiparous and having had one or more previous vaginal or cesarean deliveries. The NNM rate was associated with sociodemographic, obstetric, childbirth, and healthcare factors. Addressing this complex event requires include everything from breaking down social disparities to a robust health system that responds to calls for treatment and rehabilitation and consistently working on promotion and prevention actions in maternal and child health.