Approximately half of all childhood mortality in Papua New Guinea (PNG) occurs in the neonatal period – the first 28 days of life. In this 5-year retrospective study, causes of admissions and in-hospital mortality among 2426 neonates admitted to Modilon Hospital’s Special Care Nursery in Madang Province were investigated. The neonatal case fatality rate was 15% (370/2426; absolute range between years 12-22%). Neonatal sepsis/infection (1017, 42%), prematurity (821, 34%) and birth asphyxia/meconium aspiration (396, 16%) were the leading causes of admissions (92% of total neonatal admissions) and deaths (96%). Many deaths were potentially avoidable but were often complicated by multiple contributing factors. To reduce neonatal mortality in PNG, health professionals, the government, policy makers and communities must appreciate that improving new born survival and other neonatal outcomes are a responsibility for all. ].