Background& Objectives: Hypoglycaemia is one of the commonest metabolic problems encountered in neonatal units. In most healthy neonates, these hypoglycaemic episodes are asymptomatic and do not adversely affect the short or long tern outcome. Occurrence of hypoglycemia in high-risk neonates is well studied and described in literature, but its occurrence in exclusively breastfed term newborns remains under-evaluated, more so in developing countries like ours. The present study was conducted to know the incidence, risk factors and short-term outcome of hypoglycemia in exclusively breastfed term neonates in a tertiary care level teaching institute.Methods:This hospital-based cohort study was conducted in postnatal ward of our hospital over two years from July 2019 to June 2021 including all term neonates whose mothers agreed for exclusive breastfeeding soon after birth. Relevant maternal and neonatal data regarding risk factors were recorded. Blood glucose levels (BGL) were preferably monitored before feedings at 2, 6, 12, 24, 48 and 72 hours of life using glucometer strips. Hypoglycemia was defined as BGL <45 mg/dL.Result:Over the 2-year study period we studied 831 neonates, out of which 209 or 25.1% had one or more episodes of hypoglycemia in the first 72 hours of their life. Mean birth weight of the neonates studied was 3.09 kg ± 0.47 Kg. Out of these 209 neonates, 144 (68.9%) had only one episode of hypoglycemia while the rest 65 (31.1%) had more than 1 episode of hypoglycemia. Majority of newborns (n=164, 78.5%) had asymptomatic hypoglycemia while 21.5%(n=45) had symptoms attributable to hypoglycemia. Incidence of hypoglycemia was significantly more in first 4 hrs as compared to next 6 to 48 hrs (P=0.01). Mean (SD) blood glucose level also showed a significant gradual increase from 58.53±14.9 mg/dL at 6 hours to 89.6± 15.4mg/dl at 48 hrs (P<0.01). In univariate analysis, low birth weight (<2.5 kg), SGA, LGA, primigravida mother, LSCS delivery, unbooked case and maternal BMI >30 Kg/m2 were significantly associated with occurrence of hypoglycemia.Conclusion:A significant proportion of exclusively breastfed high-risk term newborns do suffer from hypoglycemia. Though such neonates can be effectively managed in postnatal ward, their blood glucose levels need to be monitored at least for the first 72 hours of life with special emphasis on the first 4 hours.