Background <p>Neonatal near miss (NNNM) refers to a newborn aged 0–28 days old who had a life-threatening event but survived either by chance or the quality of care received. Studies on neonatal near misses are lacking in Nigeria. This study determined the incidence, risk factors, and outcome of neonatal near misses among Lagos Island Maternity Hospital newborns.&#xa0;</p> Methods <p>A hospital-based unmatched case-control study was conducted in Lagos Island Maternity Hospital (161 cases and 321 controls). This study identified and adapted the neonatal near miss from the WHO maternal near miss tools, in which the newborn encountered at least one of the following criteria (pragmatic, management, clinical/laboratory/organ dysfunction marker) but survived the complications. We followed up with the neonates and assessed neonatal outcomes on the 28th day of life. Bivariate and multivariable logistic regression analyses were performed, and OR, 95% CI, and p-values reported.&#xa0;</p> Results <p>The incidence of NNNM was 198 per 1000 live births. The significant risk factors associated with NNNM were higher education (AOR = 3.12, 95% CI: 1.84–5.28) for NNNM, referral from another facility (AOR = 4.45, 95% CI: 2.56–7.71), ≥ four ANC visits (AOR = 0.27, 95% CI: 0.09–0.87) Antenatal admission (AOR = 2.19, 95% CI: 1.16–4.10), having fetal monitoring during labour (AOR = 3.31, 95%CI: 1.99–5.49), HDP (AOR = 2.71, 95%Cl = 1.21–6.09). The neonatal outcome on the 28th day of life revealed that all newborns recruited in this study survived even though a significant number remained on admission in the NICU.&#xa0;</p> Conclusions <p>The incidence of NNNM was high among our study population. The factors associated with NNNM were maternal education, ANC, pregnancy and delivery complications. Therefore, there is a need for policymakers and healthcare professionals to focus on NNNM by identifying life-threatening conditions for mothers and neonates during pregnancy, delivery, and the immediate postpartum period.</p>