outcome of emergency neonatal surgery is still poor in developing countries due to a lack of trained workforce, cultural barriers, and poor understanding of the patient´s physiology. Aim: the focus of this study is to review the etiology and determine factors associated with poor outcomes of neonatal intestinal obstruction in northeastern Nigeria. a retrospective study of neonates aged 28 days at two tertiary Hospitals, the University of Maiduguri Teaching Hospital and Federal Medical Centre Yola was undertaken from February 2015-January 2020. Information on patients´ clinical features, duration of symptoms, diagnosis, treatment, and outcome were analyzed. Relationship between continuous and outcome variables was analyzed using ANOVA test, P-value < 0.05 is regarded as significant, confidence interval (CI) of 95%, while the correlation between categorical variables was analyzed with the Chi-square test. the study had 147 (74.6%) boys and 50 (25.4%) girls (a boy-to-girl ratio of 2.9: 1). The mean weight of the cohort was 2.66±06 Kg. The most common causes of neonatal intestinal obstruction were anorectal malformations in 101 (51.3%), followed by intestinal atresias in 44 (22.3%), intestinal malrotations in 20 (10.2%), and Hirschsprung´s disease in 18 (9.1%). Most 124 (62.9%) neonates presented by the 5th day of life were severely dehydrated and hypothermic with signs and symptoms of intestinal obstruction. Severe dehydration and hypothermia fever were associated with high post-operative mortality in these categories of neonates presenting late. Hence, neonates with prolonged duration of symptoms statistically correlate with high post-operative mortality P< .002, CI: 6.81-8.49. anorectal malformations, intestinal atresia, and intestinal malrotation are common causes of neonatal intestinal obstruction in Nigeria.