Low birth weight (LBW) babies account for a large number of neonatal deaths globally, with over 90% of these occurring in developing countries with low resources. Identifying factors that determine survival in these sub-groups of babies in such a low-resource setting will help clinicians prioritize care and improve outcomes. This study aims to bridge some knowledge gaps in this regard. This was a 45-month prospective study carried out at the Enugu State University Teaching Hospital (ESUTH), Enugu, Nigeria. All eligible newborns weighing between 500g and and lt;2500g that were seen in this period were enrolled and monitored. Data collected were analysed with SPSS Version 24, and significant associations identified using logistic regression models. A total of 166 LBW neonates were enrolled, and 68.2% of them survived. Asphyxia and episodes recurrent apnoea were recorded at least once in 78.8% and 68.4% of the babies respectively, with about two-thirds requiring respiratory support at one time or the other. Survival in these LBW newborns was negatively associated with gestational age at birth of less than 32 weeks (OR 0.17; CI 0.03-0.50; P and lt;0.01) as well as with episodes of recurrent apnoea (OR 0.07; CI 0.02-0.34; P and lt;0.01). However, intra-uterine exposure to malaria was associated with a 15 times higher likelihood of survival (OR 15.41; CI 2.22-106.91; P=0.01). No significant associations was found between survival and attendances to antenatal care, mode of delivery, birth weight and a number of neonatal morbidities like necrotizing enterocolitis, hypothermia, hypoglycaemia, septicaemia, anaemia and neonatal jaundice. Survival rate among low birth weight neonates in a low resource setting is decreased with delivery at less than 32 weeks completed gestation as well as recurrent episodes of apnoea, but is increased with in-utero exposure to malaria.