BACKGROUND This study was conducted at the NICU of Dr B C Roy Post Graduate Institute of Paediatric Sciences, a tertiary care children’s hospital in Kolkata, West Bengal, India, to study the immediate outcome of the referred sick neonates and peripheral utilization of resources before and during transport. METHODOLOGY A prospective observational study on 250 new born babies referred to Dr. B. C. Roy Post–Graduation Institute of Paediatric Sciences, Kolkata, India during the period of June 2016 to May 2017. At the admission detailed clinical assessment of the baby has been done and clinical physiological parameters (TOPS– Temperature, Oxygenation (Airway & Breathing), Perfusion, Sugar) were recorded. Pre transport TOPS and transport TOPS were noted. The babies were followed up for the next seventy two hours to study the correlation between the utilization of the resources and immediate outcome of the babies in terms of death, cardiorespiratory support (mechanical ventilation, CPAP, inotrope therapy), supportive care and discharge within next 72 hours. RESULTS Out of 250 babies, 62% were boys, 58.4% were pre term,65% were low birth weight. 60% were transported in government ambulance. 100% mortality was present in babies taking > 2 hrs to reach the hospital. 44 babies had no alteration of TOPS parameters while one parameter was affected in 115 babies (46%), two parameters were affected in 51 babies (20.4%), three parameters were affected in 30 babies (12%) and all four parameters were affected in 10 babies (10%). Hypothermia was present in 65%, hypoxia in 34.8%, hypoperfusion in 23% and hypoglycemia in 16%. 44.8% were discharged with in 72 hours, 23.6% received supportive care, 17.2% required cardio–respiratory support and 14.4% died. CONCLUSION Emphasis on stabilization of sick new born before and during transfer should be done. Training modules to all the personnel involved in the care of a sick new born and regular practise of the same. In–utero transport by identifying the high–risk pregnancies is beter way to decrease the requirement of transport. Longer duration of transportation has a high mortality