Objective To explore the clinical characteristics of neonatal purulent meningitis(NPM), and provide evidence for early diagnosis and treatment of NPM. Methods Clinical data of neonates who were hospitalized in a neonatal ward from January 1, 2011 to December 31, 2018 and was diagnosed with NPM when they were discharged from hospital were analyzed retrospectively, according to the number of days after birth at the time of disease onset and results of blood culture and cerebrospinal fluid (CSF) culture, they were divided into different groups, diffe-rences in clinical characteristics between different groups were compared. Results The first four clinical manifestations of 81 neonates were fever (88.89%), change in consciousness (37.04%), poor milk intake (24.69%), and increased tension in the anterior fontanelle (23.46%), incidence of poor milk intake in early-onset group(onset age ≤ 7 days after birth) was higher than that in late-onset group(onset age>7 days after birth) (P<0.05); the main isolated pathogens were Escherichia coli (E. coli) and group B streptococcus(GBS); glucose content in CSF in E. coli group was lower than that in GBS group (P<0.05); neonates with positive CSF culture especially those with both positive CSF and blood culture had higher CSF pressure and CSF protein content (both P<0.05); six neonates showed that the number of CSF leukocytes was within the normal range after the first lumbar puncture within 24 hours after disease onset, 4 of whom showed a significant increase in the number of CSF leukocytes at re-examination after 48-72 hours of the first lumbar puncture; 79 neonates performed MRI or CT examination of the head, 7 of whom (8.86%) were found to have complications, 5 cases were found to have pathogens in CSF and/or blood. Conclusion Clinical manifestation of NPM is not typical, more attention should be paid to the fever of neonates, even if CSF is normal in routine and biochemical detection, diagnosis of purulent meningitis cannot be excluded, CSF re-examination should be performed timely.