Antibiotic resistance, fungemia, necrotizing enterocolitis, and death have all been linked to overuse of antibiotics and changed bacterial colonization. In order to understand the significance of antibiotic usage, particularly in the case of culture-negative newborn sepsis, it March be helpful to investigate the relationship between antibiotic exposure and neonatal outcomes other than infection-related morbidities. The present study was carried out to assess the trend in antibiotic use among all hospitalized very low birth weight (VLBW) newborns and the relationship between the prevalence of antibiotic use (AU) and mortality and morbidity in neonates without culture-proven sepsis. The study was carried out among VLBW infants hospitalized to neonatal intensive care facilities between January 1, 2019, and July 30, 2020. The AU was calculated as the total number of hospital days divided by the number of days an infant was exposed to one or more antimicrobial agents. The composite primary outcome was defined as mortality or significant morbidity, including any of the following conditions: chronic lung disease, stage 3 or higher retinopathy of prematurity, persistent periventricular echogenicity, or echolucency on neuroimaging. The connection between AUs and outcomes was determined using multivariable regression analysis, which yielded adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Among the 165 eligible VLBW newborns, 12.6 (84.9%; mean [SD] gestational age, 28.3 [2.5] weeks; 45.1% female) were included in the study because they were given antibiotics while in the hospital. The rate of late-onset sepsis declined from 21.8 % in 2019 to 13.3% in 2020 during the same time period (slope for the best-fit line, -0.011; 95% CI, -0.016 to -0.005; P .001). 84 of the 116 infants who received antibiotic treatment for varied lengths of time throughout their hospital stay were identified as having problems associated to sepsis. The odds of the key composite outcome (OR, 1.14; 95% CI, 1.21-1.41), mortality (OR, 2.56; 95% CI, 1.78-2.46), and stage 3 or higher retinopathy of prematurity (OR, 1.11; 95% CI, 1.01-1.43) increased by 10% among the remaining 82 infants without early-onset sepsis, late-onset sepsis etc. The use of antibiotics in newborns with VLBW increases between Apr 1, 2019, and July 30, 2020 because of COVID 19 pandemics. Higher AUs were linked to adverse newborn outcomes without culture-proven sepsis