Introduction A neonate nearly died but survived severe condition happened within 28 days of life by chance or therapy called neonatal near miss. Identifying determinants of neonatal near miss is helping to develop prevention for neonatal mortality; however, this evidence is limited in Northeast of Ethiopia. Therefore, study aimed to identify determinants of neonatal near miss among neonates admitted in Dessie Comprehensive and Specialized Hospitals, Northeast Ethiopia.

Method Unmatched case-control study was conducted among neonates in admitted in Dessie comprehensive and specialized hospitals Northeast Ethiopia for two months in 2022. Data were collected using interviewer administered questioner and document review. After complete check in Epi data version 3.1, data exported to STATA version 14 software for analysis. Bivariable and multivariable logistic regression were computed and AOR with 95 %CI was used to declare statiscally significant variable with neonatal near miss.

Result After keeping other factors remains constant, maternal age >35[AOR,3.14,95 % CI(1.28–7.7)], unemployed mothers [AOR,1.92,95 %,CI(1.03–2.87)], rural [AOR,1.95,95 %,CI(1.01–3.75)], hypertension [AOR, 2.17, 95 %,CI (1.07–4.5)], maternal anemia [AOR,2.6, 95 %,CI (1.11–6.27)], dystocia [AOR, 3.8 95 %,CI (1.9–7.4)], and poor newborn care practices [AOR,2.4, 95 %,CI (1.04–5.67)] were significantly related with neonatal near miss.

Conclusion Maternal age, occupational status, place of residence, hypertension, anemia, dystocia, and poor newborn care practices were determinant of neonatal near miss. Therefore, proper and timely delivery, providing essential newborn care help to prevent neonatal near miss.