This study is designated to establish the normal ctoscopic appearance of the newborn tympanic membrane, with possible variations that may sug¬gest Middle ear effusion (MEE), and to determine prospesctively the prevalence and bacteriology of MEE in neonatgs admitted to the NICU in com¬parison to a control group of full-term neonates. The present study was performed on two groups of neonates. The first included 60 neonates admitted to the NICU and the second group in-cluded 100 full-term newborn. A higher incidence of MEE has been reported among ICU neonates (30%) than among full-term neofcjats (12%). There were no statistical signific-ant for sex and age of neonates in relation to MEE affection. As regard the percentage of MEE in high risk neonates we found that 33.3% of premature babies showed MEE and 50 % of neonates with pneu¬monia had MEE. If pneumonia was complicated by septicaemia, MEE occurred in 66.7% of these cases. In case of neonates with hyperbilirubinae-mia, we diagnosed MEE in 20% of these cases. In