Neonatal septicaemia is a major cause of morbidity and mortality in developing countries. We studied 118 neonates admitted to the main referral hospital in Al-Anbar with positive blood cultures. The incidence of neonatal septicaemia for babies born at this hospital was 9.2 per 1000 live births, and mortality was 28%. Staphylococcus aureus (39%), Klebsiella pneumoniae (30%) and Escherichia coli (21%) constituted 90% of all isolates. The isolates showed in vitro susceptibility to cefotaxime, chloramphenicol and gentamicin, but resistance to more commonly used antibiotics such as ampicillin and cloxacillin. We recommend initial gentamicin/cefotaxime combined therapy while awaiting culture and sensitivity test results. Our study highlights the importance of understanding the local epidemiology of neonatal septicaemia in formulating a rational antibiotics policy.