Background: Premature rupture of membranes (PROM) increases early-onset neonatal sepsis (EONS) risk, raising morbidity and mortality. Neonatal sepsis presents nonspecifically, hindering early diagnosis. Procalcitonin (PCT) and other inflammatory markers are emerging as sensitive tools for timely detection. Objective: To find out the association between maternal serum procalcitonin level in preterm premature rupture of membrane patients with early onset of neonatal sepsis. Methods: This prospective cohort study was conducted in the Fetal-Maternal Medicine unit of the Obstetrics & Gynecology department of Dhaka Medical College Hospital, Dhaka, from January 2022 to December 2022. In this study, 99 preterm PROM patients were enrolled. After consent, the researcher interviewed each woman using a standardized questionnaire. Maternal venous blood (3ml) was collected aseptically on admission. Serum procalcitonin was measured via chemiluminescence (sandwich technique). Neonates were followed for EONS signs within 3 days, confirmed by CBC/CRP. SPSS 26.0 analyzed the data. Results: Most patients (53.5%) were aged 18–25 years (mean 25.2±5.1). Elevated maternal procalcitonin (>0.05 ng/ml) occurred in 61.6%. Neonatal survival was 90.9% (90/99); 9.1% died. Among 90 live neonates, 17.7% had lethargy/poor feeding, 10% respiratory distress. EONS was culture-confirmed in 8 babies (8.9%), all with elevated maternal procalcitonin (p=0.016, RR 1.74, 95% CI). Conclusion: Early-onset neonatal sepsis occurred in 8.9%, significantly linked to elevated maternal procalcitonin. Thus, maternal serum procalcitonin in preterm PROM is a useful, non-invasive biomarker for assessing EONS association.