BACKground: The neonatal period (<28 days) is most vulnerable for child survival. Globally   among all the deaths under five years in 2018, 47% are neonatal deaths. Most of these deaths are  due to preventable and treatable causes like infections and intra-partum injury. It is important to  understand underlying causes of neonatal death. The role of autopsy is very crucial in establishing
the facts about death which helps to plan national and global health strategies. Aims: To evaluate the spectrum of neonatal pathology, estimate frequency of neonatal pathology and to address the most common neonatal pathology. mAteriAl And methods: A retrospective observational study of neonatal medicolegal autopsy cases received from January 2022 to December 2022 in autopsy section at Tertiary health care centre, Pune. Gross and microscopic examination was done. All the results were tabulated and analysed.  results: 93 cases were studied, out of which 73 early neonates (<= 7 days), 20 late neonates (>7 days),
M:F = 1.06:1. The most common cause of death was lung pathology 96.7% cases, pulmonary haemorrhage (24.44%) and meconium aspiration (24.44%) were predominant lesion, pulmonary oedema (17.77%) and  pneumonia (15.55%). Central nervous system (CNS) manifestations 10.75% and Liver Pathology 6.45%. Rare pathologies include Congenital Heart Disease (1.07%) and Renal pathology (1.07%). ConClusions: It is vital to study the spectrum of histopathological features in neonatal deaths
as it provides adequate diagnosis which helps to plan appropriate resource and management strategies in tertiary health care centre.