Introduction: Neonatal mortality remains a major public health concern in India, particularly in tertiary care settings catering to rural and socioeconomically disadvantaged populations. Prematurity, low birth weight, birth asphyxia, and infections are recognized as leading contributors to neonatal deaths. Understanding the pattern of risk factors and causes of mortality is essential for planning targeted interventions. Aim: To assess the risk factors and determine the causes of mortality among neonates admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary care centre. Materials and Methods: This hospital-based cross-sectional study was conducted in the NICU of Mahatma Gandhi Memorial Medical College & Hospital, Jamshedpur. A total of 317 neonates aged less than 28 days admitted during the study period were included using purposive sampling. Data were collected using a structured case record form after obtaining written informed consent from parents or guardians. Information regarding demographic profile, neonatal and maternal risk factors, clinical characteristics, and causes of death was recorded and analyzed descriptively. Results: Among 317 neonates, 60.88% were males and 76.66% belonged to rural areas, with 56.47% from tribal communities. Preterm births accounted for 41.01% of admissions. Low birth weight (39.43%) and very low/extremely low birth weight (14.83%) constituted a significant proportion. Birth asphyxia (29.97%) and intrauterine growth restriction (29.02%) were common clinical findings. Intrauterine hypoxia (16.72%) was the leading cause of neonatal death, followed by respiratory distress syndrome (8.52%) and meconium aspiration (5.68%). A majority of deaths occurred during the late neonatal period (57.73%). Maternal risk factors such as preterm labour (18.93%) and hypertensive disorders (8.52%) were notable contributors. Conclusion: Neonatal mortality in this tertiary care NICU is predominantly associated with prematurity, low birth weight, birth asphyxia, and maternal complications. Strengthening antenatal care, improving intrapartum management, and enhancing NICU-based supportive care are essential to reduce preventable neonatal deaths, particularly among rural and socioeconomically vulnerable populations