Introduction: The birth rate in India is estimated to be 26,932,586 per year. Of these 27 million babies born each year, 1 million babies die before the age of 1 month; India carries the highest share with 30% of global neonatal mortality. Three neonates are dying every minute in India and every fourth baby born has a low birth weight. Low birth weight directly or indirectly contributes to 60- 80% of all neonatal death. Aim: We aimed to assess the impact of preterm birth and low birth weight on medical conditions, medications use and mortality among neonates in a resource-limited setting. Methodology: A prospective observational study was conducted at the neonatal intensive care unit (NICU) over 6 months. Neonates of either sex admitted to NICU and who received at least one medication were enrolled in the study. Perinatal and demographic data, reasons for NICU admission, medications prescribed, and discharge status were documented and analysed. Result: Four hundred and four neonates were included in the study: 61.1% were boys, 38.9% were girls. Respiratory distress syndrome (n=120, 29.7%), neonatal jaundice (60, 14.85%), and sepsis (44, 10.9%) were the most commonly observed conditions and were significantly more common among preterm and low birth weight neonates. Nearly half of the medications prescribed were antibiotics (n=1113, 49.6%). The mean number of medications prescribed to each neonate is 5.5. The mortality rate was significantly higher in extremely preterm and very preterm when compared to term neonates. Conclusion: Medical conditions, medications prescribed and the mortality rate was significantly higher among preterm and low birth weight neonates admitted in the NICU that are included in the study.