Discharge against medical advice among neonates is worrisome as there have been no substantial changes in neonatal mortality in Nigeria in the last decade. This study was carried out to determine the trend of discharge against medical advice among neonates in southern Nigeria and the impact of policy changes over a ten-year period. This retrospective study was carried out among neonates at the Special Care Baby Unit of the Niger Delta University Teaching Hospital, Bayelsa State. Relevant information was obtained and analyzed. The prevalence of neonatal discharge against medical advice was 3.97%, with a mean age of 4.81±5.33 days and a male to female ratio of 1.4:1. It declined from 1.82% in 2009 to 0.85% in 2011 and rose sharply to 9.37% in 2013. A50% fees waiver in 2015 had no impact, while a health insurance scheme in 2017 saw a decline to 3.52%. Neonatal sepsis was the most common diagnosis. Most [43 (56.2%)] discharges against medical advice occurred within six days of admission. Forty-three (58.90%) parents were in the low socioeconomic class and none had health insurance. A lack of finance was the major reason in 74% of neonates and in 76.7% of cases fathers were the main signatories. The prevalence of discharge against medical advice among neonates over the 10-year period remained high, with financial constraint being the main reason and sepsis the most common diagnosis. Universal health insurance will impact positively on its prevalence and improve child health.