Aims: serum albumin has been used in the neonatal population to assess for the presence of inflammation and predict mortality. In preterm low level of albumin level on the 1st day of life significantly increase the risks of the later development of clinical disorders. The aim of this study was to assess the value of measuring serum albumin level on the 1st day of life in detecting severity, morbidity, and mortality of preterm infants Patients and Methods: A prospective, cross sectional study was conducted on 82 preterm neonates (GA<37 weeks), who had been admitted to the neonatal ward at the child’s central teaching hospital within 24 hours after birth, from the 1st of Jan to the 31st of June 2020. For all cases, detailed history and full examination was done and. Laboratory tests were send according to presumed diagnosis but in all cases, serum albumin was sent within first 24 hours of life. All survived cases followed for 30 days following discharge. Results: A total of 82 patients, birth weight were 2.11 ± 0.74 g, gestational age was 33.49 ± 2.74 weeks and 58.45% were male. 22 neonates (26.8%) were in the low albumin group. From preterm with hypoalbuminemia 45.45% of patients develop RDS, 40.91% sepsis, and 13.64% develop pneumonia, sepsis was significantly higher in preterm with hypoalbuminemia (p-value 0.001). The laboratory parameters in this study do not show any significant correlation with low serum albumin level. The median duration of CPAP and total O2 were higher in neonates with hypoalbuminemia (2.0 hours and 4.5 hours respectively) than those with normal albumin level. Low albumin level had no significant correlation with duration of mechanical ventilation or length of hospital stay but show significant correlation with mortality of preterm babies. Conclusion: In the first day of life, low serum albumin level in preterm neonate significantly correlate with sepsis and indicate higher risk of mortality. Albumin level has no relation to duration of hospitalization or mechanical ventilation.