The infant mortality rate is a indicator of both health and access to health care in a developing country. Non-institutional births account for a considerable fraction of overall births in developing countries, where many deliveries are still performed at home, particularly in rural areas 1 . In developing nations, the most common causes of neonatal mortality are prematurity, hypoxia, and sepsis.2 . Many of the neonates carried are chilly, blue, and hypoglycaemic, and these babies have major clinical consequences. The National Ambulance Service (NAS), which provides free services to mothers and neonates, has also eased patient referral to tertiary care institutions. Although free ambulance service is now provided in virtually every section of the country, the bulk of these vehicles are not equipped to carry neonates. Furthermore, they are frequently not staffed by trained healthcare personnel. As a result, while the ambulance service has successfully transported a large number of unwell neonates to tertiary care centres in a timely manner, the quality of care prior to and during transport is far from optimal. Furthermore, unlike in developed countries, our country lacks integrated referral and transportation services. Consultation prior to referral, communication, and stabilisation are not routine. As a result, a high proportion of neonates arrive at tertiary care institutions in poor condition and are either unable to be saved or have a lengthy and complicated hospital stay3 . Temperature, oxygen saturation, skin perfusion, and blood sugar all have a negative impact on neonatal physiology (TOPS). TOPS score is a straightforward and useful method of assessment that may be used right away, at the time of admission4,5