Background: Neonatal sepsis is a common occurrence in our part of the world, characterized by signs and symptoms of bacterial infection during first 28 days of life. Diagnosis of neonatal sepsis may be difficult as the early signs of sepsis may be subtle and not specific. Objective: This study was to determine the accuracy of a simple and cost effective hematological scoring system (HSS) in the early diagnosis of neonatal sepsis using blood culture as a gold standard. Methods: The cross-sectional study enrolled 62 neonates who were clinically suspected of sepsis. The neonatal hematological parameter was measured in all cases. All subjects were analyzed according to HSS. Blood culture was taken for the gold standard of proven sepsis. Results: Proven sepsis confirmed by blood culture was found in 34% of neonates. The HSS was found to have a sensitivity of 80.9%, specificity of 92.7%, positive predictive value of 85%, negative predictive value of 90.5%, positive likelihood ratio of 11.1, negative likelihood ratio of 0.2, and accuracy of 88.7%. Conclusion: The HSS is a simple cost effective tool that can be used to early diagnose of neonatal sepsis.