To determine the prevalence of neonatal tetanus and frequency of factor leading to neonatal tetanus in patients visiting to Nishtar Hospital, Multan and comparing this data with the past since 2002. January 2009 to December 2011. Descriptive study [cross-sectional]. ln this study 64 patients with neonatal tetanus were observed over a period of 03 years from January 2009 to December 2011. The ages of babies were from 3-28 days. Mean age was 7.89 + 1.23 days the total number of cases rose significantly from 0.8% of total admission in 2002 to 1.71% in 2011. The commonest risk factor was delivery of baby conducted at home [100%]. 2 nd commonest factor was non immunized mothers, 95% of mothers were non immunized against tetanus in pregnancy.5% were either partially immunized [received one dose of T. T] or showed vaccine failure despite 2 doses of immunization. ln 80% of the cases there were unskilled birth attendants who conducted deliveries. Among tools which were used to cut umbilical cord, blades were 45% knives were 30%, and scissors were 25%. Ghee application on cord was found to be present in 30% of the cases. While Surma applied on cord was 40%. As far as sex is concerned, 45% cases were females and 55% cases were males. Majority [70%] of cases were of normal birth weight [>2.5kg] while 30% cases were of low birth weight [<2.5kg]. lnability to take feed/lock jaw [95%], and fits [96%] were the two most common symptoms.0ther less common symptoms were fever [70%] and generalized stiffness [85%]. All the patients were born at home by spontaneous vaginal delivery. The number of neonatal tetanus cases are increasing progressively despite the claims of wide coverage of Tetanus Toxoid Vaccination of female population by EPl. ln our setup the factors which lead to Neonatal Tetanus are; non immunization of mothers during pregnancy, home delivery, delivery by non skilled birth attendants, application of ghee/surma on umbilical cord and cutting of umbilical cord by unsterilized tools [scissors, kitchen knife, blade]. If proper immunization antenatal care and hygienic delivery practices are followed and all these factors are overcome, disease can be controlled and mortality can be reduced.