Ventilator associated pneumonia (VAP) is pneumonia in mechanically ventilated patients that develops at 48 hours or later after the patient on mechanical ventilation. Ventilator associated pneumonia is the second most common cause of nosocomial infections (20% of nosocomial infections) in the neonatal intensive care unit (NICU). To investigate risk factors, causative bacteria, and outcome of VAP in the neonatal intensive care unit (NICU). The research was conducted from March 2022 to June 2022 with a cross-sectional design in the NICU of Prof. RSUP. R. D. Kandou Manado. Causative bacteria were isolated from endotracheal tube (ETT) Data were analyzed using logistic regression with significance of p<0.05. Of the 50 subjects, 34 neonates (68.0%) were diagnosed with VAP. The mortality rate in the VAP group was 36.4% and the non-VAP group was 35.3%. There was no relationship between sex, duration of mechanical ventilation and duration of stay in the NICU on the incidence of VAP in neonates. Whereas, age, gestational age and birth weight associated with the incidence of VAP in neonates. The median (IQR) of age in the VAP group was 5(1.7-7.2) and 2(0-3) in the non-VAP group with a p of 0.003. The median (IQR) of gestational age in the VAP group was 35.5 (32-38) and 38(37-38) in the nno-VAP group with a p of 0.05. Birth weight <2500 gr was associated with the incidence of VAP in neonates with a p of 0.001. The most common type of bacteria found was Klebsiella Pneumoniae sp. with a proportion of 26.4% and Acinetobacter Baumannii with a proportion of 23.5%. VAP causes a high rate of neonatal mortality. Age, gestational age, and birth weight are associated with the incidence of VAP in neonates. The most common bacteria that cause VAP are Klebsiella Pneumoniae sp and Acinetobacter Baumannii.