Background: Neonatal intestinal obstruction is the most common surgical emergency in newborn. The pattern and outcome of intestinal obstruction are not well studied among neonates admitted to Hawassa specialized compressive hospital. Thus this study aims to assess pattern of intestinal obstruction in neonate admitted to the NICU) in HUCSH. Objective: To assess pattern of neonatal obstruction admitted to the NICU of HUCSH over the last year 2year (January 2020-2022). Methodology: A Hospital-based cross-sectional study was conducted from July 2022 to September/2022. All 104 cases with intestinal obstruction during study period were included. Data was collected by trained data collectors using a structured questionnaire and the data will be cleaned, entered, processed, and analyzed using SPSS version 25. Result: out of 104 patients, male were 71(68.3%), female 31(31.9%) and male to female ratio 2:1.The most common cause of intestinal obstruction was ARM 47(45%) and HSD 26(28.9%) followed by duodenal atresia 8(7.7 %). Majority of neonate present within the first week of life 70(67.7%) and survival rate was 71 (67%). Mortality is higher in preterm 9 (64.2%) than term 24(26.6%). Conclusion: Anorectal malformation is a leading cause of obstruction followed by HSD. The incidence is higher in males than female. Overall survival rate is 78% with Hirschsprung’s disease and 72% with anorectal malformation. Intestinal atresia is the major cause of mortality occupying 47 % of total mortality.