Sepsis is a common cause of morbidity and mortality among neonates, and current biomarkers for diagnosis are not adequate. The objective of the study was to assess the diagnostic and prognostic value of presepsin. Methods:-One hundred and twenty neonates were enrolled in the study; 80 cases and 40 controls. Presepsin and CRP levels were measured during 1st, 2nd& 6th days of admission for cases while were measured once for each control. Results:-Initial presepsin levels were significantly higher in group produced neonatal sepsis than in the non-septic group. At a cut off value ≥ 0.722 μg/L, Presepsin sensitivity for prediction of neonatal sepsis was 100 %, specificity 97.5%, positive predictive value (PPV) 98.7%, negative predictive value (NPV) 100%, area under curve (AUC) 0.99 with high sensitive positive correlation with sepsis (P value < 0.001). At a cut off value < 2.3 μg/L, Its prognostic sensitivity was 75.9%, specificity 72.5%, PPV 61.1, NPV 84.1 and AUC 0.76. Conclusion:-Presepsin sensitivity for early diagnosis of neonatal sepsis was 100 % with specificity 97.5%. Presepsin is an accurate biomarker for early diagnosis of neonatal sepsis. It also provides a useful tool for prediction of improving.