Late onset neonatal sepsis often presents as neonatal meningitis, which is inflammatory response cerebrospinal fluid and pia-arachnoid infection. High clinical suspicion, prompt diagnosis, immediate institution of therapy and early recognition and management of complications can make a huge difference in the neurological outcome as well as decreased mortality (1). Clinically it can be challenging to evaluate the severity, exact location, and degree of insult to the brain. Cranial sonography (CRS) is of utmost importance in evaluation of sick neonates at bedside due to its portability and is an excellent screening tool due to its non-ionizing properties. CRS has high accuracy in evaluating initial signs as well as complications of bacterial meningitis (2). MRI provides excellent image quality, but its clinical use in NICU’s is currently limited because of costs, logistic and safety issues. MRI and ultrasound are clearly complementary techniques. CT scan is often used in a minor number of cases due to its disadvantages, including but not limited to ionizing radiation and need for sedation.