Background: Neonatal hypoglycaemia is a common metabolic disorder associated with significant morbidity if unrecognized. Early identification of risk factors is essential for timely intervention, particularly in high-risk neonates in tertiary care settings. This study aimed to assess the demographic, perinatal, and clinical factors associated with neonatal hypoglycaemia. Material and Methods: A cross-sectional, observational study was conducted over 18 months (July 2024–December 2024) at the NICU of Gujarat Adani Institute of Medical Sciences and G.K. General Hospital, Bhuj. A total of 100 neonates with hypoglycaemia (random blood sugar <45 mg/dL) were enrolled using convenience sampling. Clinical and demographic data, birth weight, gestational age, maternal history, and perinatal risk factors were recorded. Blood glucose was measured using glucometers, with confirmatory laboratory testing where required. Data were analyzed using SPSS v29, with descriptive statistics and associations evaluated at a significance level of p < 0.05. Results: Among the neonates, 62% were male and 38% female. Late preterm (34%) and term (31%) infants predominated. Based on gestational growth, 45% were AGA, 33% SGA, and 22% LGA. Inborn neonates comprised 78% of the cohort. Birth weight distribution showed 48% normal, 44% LBW, 7% VLBW, and 1% ELBW, with a mean weight of 2.74 ± 0.80 kg. Common risk factors included sepsis (56%), pregnancy-induced hypertension (42%), IDM (27%), IUGR (33%), polycythaemia (21%), and other comorbidities (32%). Clinical manifestations were largely absent; symptomatic neonates presented with jitteriness (6%), lethargy (4%), seizures (4%), and refusal to feed (2%). Conclusion: Sepsis, maternal PIH, and diabetes were prominent risk factors for neonatal hypoglycaemia. Most affected neonates were asymptomatic, emphasizing the need for routine glucose monitoring and early risk-based intervention to prevent adverse outcomes.