Background; Neonatal sepsis is a major contributory factor to morbidity and perinatal mortality in Tanzania. A considerable number of newborn infants delivered at Kilimanjaro Christian Medical Centre (KCMC) and other newborn infants are born from outside KCMC are admitted in the neonatal ward Neonatal sepsis is among the top ten common causes of morbidity and mortality in Paediatric admissions. At KCMC in the year 2003 neonatal mortality was shown to be 21.3% among those with clinical diagnosis of neonatal sepsis. Aim; to identify the aetiology and pattern of antibiotic sensitivity in neonates with sepsis and their outcome among those admitted in neonatal ward at KCMC during October 2010 to February 2011. Methodology; this was a hospital based prospective cross-sectional study conducted at KCMC neonatal ward. This involved all newborn infants who fulfil the criteria of having signs and symptoms of neonatal sepsis regardless of their gestational ages. Standard data collection tool was used to collect demographic data and clinical characteristic of neonates. Blood culture was done on Brain Heart Infusion broth followed by identification using conventional methods and testing for their susceptibility to antimicrobial agents using the disc diffusion method. Statistical package for social sciences (SPSS) version 15.0 was used to process and analyze the data. Results; Out of 721neonates admitted, 210 (29.1%) neonates were diagnosed to have neonatal sepsis by WHO criteria. One hundred and forty three (68.1%) vs. 67 (31.9%) had early and late onset sepsis respectively. Positive blood culture was found in 71 (33.8%) neonates, out of them 62.5% meconium stained liquor. Isolates were S.aureus (49.3%) followed by CoNS (19.7%) and E.coli (19.7%), isolated organisms did not show high resistant to commonly used drugs in the unit. Deaths occurred in 25 (11.9%) of neonates with signs and symptoms associated with sepsis. Most of the deaths occurred within the 1st 7 days after admission (96%). Conclusion and Recommendation; S.aureus and E.coli predominate the aetiology of neonatal sepsis at KCMC. Susceptibility pattern of bacteria identified did not indicate high rate of resistant organism to commonly used antibiotics though there is decreased sensitivity compared to a previous study done at KCMC in neonatal unit and this shows emerging of resistant to commonly used antibiotic. Neonatal mortality is high in our setting, most deaths occurring within the first 7 days of admission. Improved hygiene, early diagnosis and appropriate treatment are important measures in reducing neonatal mortality as a result of sepsis in our setting. Routine bacterial surveillance and the study of their sensitivity patterns must be an essential component of neonatal care.