Introduction: The World Health Organization (2023) has identified neonatal asphyxia as being the third leading cause of early newborn deaths globally, accounting for approximately 24% of neonatal mortality (Workineh et al., 2020) found out that 24% of African births are affected by asphyxia. In Kenya, birth asphyxia accounts for 29% of deaths of neonates, and Nakuru County has a perinatal death rate (15/1000 live births) that surpasses WHO recommendations ((Ngare et al., 2020). The WHO recommends a maximum of 12 fatalities per 1000 live births and suggests interventions such as drying, stimulating, and warming newborns with birth asphyxia (Moshiro et al., 2019) Objective: To identify primary factors contributing to neonatal birth asphyxia at Naivasha Sub-County Hospital. Methods: A retrospective cross-sectional study design, using secondary data collected from the hospital's Newborn Unit records was used with the target population of asphyxiated neonates with APGAR scoring < 7 within the first minute of extra uterine life. Results: The highest incidence was observed in those aged 13-25 years (38%), married (65%), with secondary education (60%), and who attended their first ANC visit (56%). Employment status also played a role, with unemployed mothers contributing to 37% of cases. Foetal factors, such as low birth weight (55.83%), premature gestation (57.5%), vertex presentation (63.33%), and male sex (60.42%), significantly increased the risk. Maternal-obstetric factors, including PROM (42%), meconium-stained liquor (53%), infections (33%), pre-eclampsia (44%), and prolonged labour (28%), were prevalent, though not significantly different in their impact. Statistical analysis revealed significant differences among socio-demographic and foetal factors, while maternal-obstetric factors showed no significant variation in their contribution to birth asphyxia. Conclusion: Birth asphyxia remains a significant concern, with key contributors identified as socio-demographic