Objective: To evaluate the neonatal outcome of second twin compared to first twin. Design: A retrospective, cross-sectional study Setting: Department of Obstetric and Gynaecology, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). Patient(s): All twins delivered in UKMMC from January 2011 to December 2013 which fulfilled the inclusion criteria were included in the study. Intervention(s): None Main Outcome Measure(s): Parental socio-demographic information, maternal obstetric history, complications of the pregnancy, labour and delivery, birth weight, gestational age, and other infant outcomes were analyzed. Result(s): A total of 162 patients were enrolled in this study. Mean age of patients was 31 years old and the majority was Malay. The highest mode of delivery was via lower segment caesarean section (63%), followed by both SVD (30.8%) and SVD followed by assisted breech delivery (6.2%). There was no significant difference in the Apgar score less than 7 in 1 minute, Apgar score less than 9 in 5 minutes and cord pH in the second twin delivered at any gestational ages. In all modes of deliveries, the second twin had a significantly higher outcome with a cord pH of less than 7.2 without any difference in the Apgar score less than 7 in 1 minute and Apgar score less than 9 in 5 minutes. However, the NICU admission and requirement of intubation for the second twin delivered at any gestation and all modes of deliveries was not statistically significant. Conclusion: The second twin had no difference in neonatal outcome compared to the first twin except in a significant higher outcome with a cord pH less than 7.2 in all modes of deliveries.