Background: Various scoring systems are extensively applied in neonatal intensive care unit(NICU) to predict the immediate outcome of neonates and ESNS is one of those. None of the study in literature has used ESNS as long term predictor of morbidity in terms of neuro developmental outcome who survived in neonatal period. Aims and Objectives: Primary Objective:-. To determine immediate outcome of sick newborn using ESNS. Secondary Objective:- To assess applicability of ESNS for predicting neuro developmental outcome at one year of age. Methods: It was a hospital based prospective cohort study conducted over eighteen months in which 220 term neonates admitted were enrolled and the required parameters for ESNS were assessed. Immediate outcome was documented in terms of death, discharge and duration of stay. Neuro-developmental outcome between 12±3 months of age was assessed by The Bayley scales of infant and toddler development (Bayley – 4). Results: Mortality rate was 48.2% in neonates with ESNS score <13 while only 1.5% in neonates with ESNS score of ≥13. The sensitivity for predicting immediate outcome was 75.8% and specificity of 95.2%. While to predict long term neuro-developmental impairment, 85% cases were developmentally delayed in ≥1 domain in ESNS <13 group while only 6.5% in ESNS ≥13 group. Cut off score of 13 had sensitivity of 95% and specificity of 88%(p <0.001). Conclusion: ESNS can predict immediate outcome as well as long term neurodevelopmental outcome with satisfactory sensitivity and specificity.