Background: Neonatal morbidity and mortality remain critical public health challenges in low- and middle-income countries. Neonatal Intensive Care Units (NICUs) play an essential role in improving neonatal survival. Understanding admission patterns and clinical outcomes is vital for clinical auditing, resource allocation, and optimizing perinatal care protocols. Objective: To evaluate the patterns, clinical indications, maternal-neonatal determinants, and outcomes of neonates admitted to the NICU at Omdurman Maternity Hospital, Sudan. Methods: A hospital-based descriptive analytical cross-sectional study was conducted between October 20 and December 20, 2025. A consecutive sample of 50 neonates admitted to the NICU was enrolled. Maternal, neonatal, clinical, and therapeutic data were extracted retrospectively from medical records using a structured data collection instrument. Statistical analyses were performed using SPSS version 27.0, applying descriptive metrics and Chi-square / Fisher's exact tests to examine associations between delivery mode and clinical outcomes. Results: Most mothers were aged 25–30 years (46.0%), with 86.0% attending antenatal care. Emergency cesarean section was the primary mode of delivery (52.0%). Preterm neonates (<37 weeks) accounted for 60.0% of admissions, and low birth weight (<2500 g) constituted 84.0% (LBW: 44.0%, VLBW: 32.0%, ELBW: 8.0%). Neonatal resuscitation at birth was required in 72.0% of cases. The predominant indication for admission was respiratory distress syndrome (RDS) (74.0%), followed by suspected neonatal sepsis (18.0%). During hospitalization, acquired sepsis occurred in 28.0%, and 50.0% had a hospital stay exceeding 7 days. Overall in-hospital mortality was 2.0% (n=1), with 56.0% discharged either fully recovered or clinically improved. Mode of delivery was significantly associated with hospital-acquired sepsis (p = 0.002), but not with length of stay (p = 0.233) or final disposition (p = 0.367). Conclusion: Prematurity, low birth weight, and RDS represent the primary burden of NICU admissions in this setting. Enhancing intrapartum monitoring, universal access to continuous positive airway pressure (CPAP), and rigorous infection prevention programs are crucial to improving neonatal outcomes in resource-limited tertiary centers.