Background: Blood neutrophil gelatinase-associated lipocalin (NGAL) has been shown to be helpful for acute kidney injury (AKI) in pediatric patients and adults. Whether this is true in neonates remains unclear. Methods: A systemic review and diagnostic meta-analysis was performed. Keywords included blood NGAL/serum NGAL, neonate/newborn, and AKI/acute kidney failure. Eligible studies measured blood or serum NGAL levels in neonates with AM (first 30 days of life). Studies were excluded if they did not present sufficient data to extract or calculate true positives, false positives, false negatives, and true negatives, or were not available in English. Results: Five of 50 studies were included with 159 critically ill neonates and 251 measurements of blood NGAL concentrations. The overall pooled positive and negative likelihood ratios were 5.84 (95% CI 2.68 - 12.75) and 0.23 (95% CI 0.14 - 0.38). The area under the receiver operating characteristic curve was 0.87 and the Q value was 0.823. The overall pooled sensitivity and specificity of all studies were 0.813 (95% CI: 0.697 - 0.891) and 0.859 (95% CI: 0.730 - 0.932). The pooled diagnostic odds ratio was 27.20 (95% CI 8.84 - 83.74), with Cochran's Q = 4.07 (p = 0.397). No publication bias was found. Conclusions: Blood NGAL could be used as diagnostic marker for AM in neonates.