Neonatal sepsis is a major cause of morbidity and mortality among newborns in the developing world. In a consecutive cohort of 292 infants with culture proven neonatal sepsis, the mortality was 68 (22 per cent). We analysed the association of predisposing factors, clinical, and laboratory characteristics of the infected newborns with mortality by univariate methods and logistic regression analysis. Comparatively higher rates of mortality were seen among home-delivered newborn infants and those referred from other maternity facilities. The mortality was significantly higher among infants weighing < 1500 g and those with birth asphyxia (P < 0.05). The overall mortality was higher for gram negative infections and the highest case fatality rates were seen in infections with Pseudomonas species (52 per cent) and Streptococcus pneumoniae (100 per cent). Several clinical features suggestive of septicaemic shock and metabolic derangement were associated with significantly increase risk of death. Of these, the logistic regression model identified hypotensive shock (odds ratio 3.6) and acute renal failure (odds ratio 11.2) as significant factors associated with risk of death. Our data suggest that delayed presentation and recognition of neonatal sepsis is associated with rapid development of multiorgan dysfunction and increased risk of mortality.