Advisors: Teshale Mulatu (MSc, Ass’t Professor) Introduction: The burden of neonatal hypoglycemia is very high and it is interlinked with numerous neonatal complications and mortality. The diagnosis and management of clinically significant hypoglycemia remain controversial due to varying definitions in clinical context. Investigating the determinants among neonates in neonatal intensive care units is crucial for developing preventive strategies and reducing the burden. However, there are limited studies conducted in Ethiopia in general and in the specific study setting. Objective: This study aimed to assess determinants of neonatal hypoglycemia among neonates admitted at Neonatal Intensive Care unit of public hospitals in West Shoa, Oromia, Ethiopia, 2025 Method: An institutional-based, unmatched case-control study was conducted among 258 (86 cases and 172 controls) neonates admitted to the neonatal intensive care unit of public hospitals in West Shoa, Oromia, Ethiopia from February 25, 2025 to March 25, 2025. A systematic random sampling method was used to select controls and cases were selected consecutively. Data were collected using a pretested chart review extraction tool. Logistic regression analysis was performed to identify the determinants of neonatal hypoglycemia. The adjusted odds ratios with their respective 95% confidence intervals are used, and a p-value <0.05 is considered statistically significant. Result: In this study, Overall successful Retrieval Rate for controls were 96.5%, while for cases were 100 % retrieval rate. Educational status (no formal education :- AOR = 9.37, 95% CI: 1.92–45.80 ), Gestational age (> 42 weeks:- AOR = 10.94, 95% CI: 1.53 – 78.08), Intrapartum haemorrhage ( AOR = 8.96, 95% CI: 1.59–50.36 ), Small for gestational age (AOR = 15.83 (95 CI: 2.28–109.69) were significantly associated with neonatal hypoglycemia. Conclusion: Findings of this study revealed that maternal education, gestational age, intrapartum complications, and neonatal growth status play critical roles in the occurrence of neonatal hypoglycaemia. Give prority, for mothers with no formal educational to enhancing maternal education, mitigating in addressing intrapartum haemorrhage, close monitoring of post-term pregnancies and neonate born post-term, SGA, and mothers with intrapartum complications (intapartum hemorrhage) should have routine blood glucose screening of hypoglycemia, to prevent neonatal hypoglycemia. Keywords- Hypoglycemia, Determinants,Neonates, Neonatal Intensive Care Unit, West Shoa