Background: Neonates are vulnerable population and at high risk of developing drug‑related problems. The extremely low birth weight (ELBW) infants require extended hospital stay in the Neonatal Intensive Care Unit (NICU). This study was aimed to evaluate the medications and total parenteral nutrition (TPN) practices at a NICU and to evaluate the clinical significance of medicine management made by the pharmacist and to assess the perception of healthcare professionals. Materials and Methods: It is a prospective observational study conducted for 7 months in the NICU of a multidisciplinary advanced super specialty hospital, accredited by the National Accreditation Board for Hospitals and Healthcare. This study is approved by the Institutional Ethics Committee. A total of 51 neonates who met inclusion criteria were included in this study. Data were collected, and all statistical analyses were performed using the GraphPad Prism 6 Demo. Variables were compared with rho Spearman nonparametric correlations and paired t‑tests. Results: The present study showed that after administration of TPN, there was a significant change in the birth weight only in ELBW and very low birth weight (VLBW) neonates (P < 0.05). The average weight gain was more in the ELBW and VLBW groups. The study also measured the height of the preterm neonates before and after administration of TPN, and it was observed that VLBW group showed a significant increase in the height after administration of TPN (P < 0.05). About 0.27 cm average increase was observed from the VLBW group. Statistical analysis showed that head circumference gain after TPN administration was significant for birth weight <1000 g and 1000–1500 g neonates (P value 0.0192, 0.0001, respectively). Conclusion: TPN and medication practices at the NICU should be highly monitored for avoiding medication errors, drug interactions, and mortality rate in neonates. The most effective method can be achieved when a clinical pharmacist become a part of it.