Background: Neonatal period is the most vulnerable time for the survival of newborns. Despite many efforts done toimprove the outcome of neonates admitted to hospitals; it doesn’t show satisfactory progress. The study aimed to assessthe pattern, causes of admission, and factors associated with treatment outcomes.Methods: facility-based cross-sectional study design was conducted among 707 randomly selected neonates from March1 to 31, 2020. Data were extracted from medical records using a checklist adapted from the national neonatal registration book. The data were inserted into Epi-data version 3.1 and then exported into SPSS window version 22 for analysis.Bivariate and multivariate analyses were done to identify the association between independent variables and the outcome variable.Results: From 698 admitted neonates during the 2 years period, 594 of them were improved and 104 of them were notimproved. Neonatal sepsis, hypothermia, and low birth weight were the leading causes of admission to the hospital. Residency [ AOR=2.30, 95%CI: (1.3, 4.12)], low birth weight [AOR=2.52,95%CI:(1.24,5.13))], respiratory distress syndrome[AOR =2.86, 95%CI:(1.11.7.35)], neonatal sepsis [AOR= 2.48, 95%CI: (1.40, 4.38)], and neonates treated with phototherapy and oxygen [AOR=0.22, 95%CI:(0.088,0.54)], [AOR=0.47,95%CI:(0.22,0.99)] were factors associated with poor treatment outcome.Conclusion: The causes of admission in the study setting were mainly neonatal sepsis, hypothermia, and low birthweight. Residency, low birth weight, respiratory distress syndrome, having neonatal sepsis, treatment with phototherapy, and treatment with oxygen were independent factors. The hospital administrators and staff should strengthen thequality of care provided at the unit and strengthening early detection and prevention of neonatal problems during postpartum periods are means of decreasing poor treatment outcomes.