Neonatalhealthassessme nts are essential to guide postnatal care, particularly in low-resource settings. The APGAR score — based on Appearance, Pulse, Grimace, Activity and Respiration — refers to the rapid evaluation of newborns' physiological position as of birth. Problem Statement: The APGAR score, a key neonatal assessment tool, may predict feeding outcomes and neurodevelopment. In underserved districts in Ghana, limited evidence and poor postnatal care hinder early risk identification. Study Aim: This study aimed to assess the predictive value of APGAR for feeding outcomes to guide clinical decision makers in two rural districts— Gushegu and Nkwanta South—in Ghana. Methodology: A total of 322 neonates from health facilities in Gushegu and Nkwanta South districts were sampled using a stratified random sampling approach. APGAR scores were recorded within five minutes post-birth. Feeding parameters—including breastfeeding initiation, frequency, and dietary adequacy—were assessed at 48 hours, 3 months, 6 months and 9 months through structured interviews, clinical record reviews, and direct observations. Associations and contextual factors were analyzed using logistic regression, chi-square tests, and correlation analyses, with significance set at p < 0.05 for both within-andbetween-group comparisons.Findings:Neonates with APGAR scores ≤6 had 3.4× the risk of encountering feeding difficulty (OR = 3.4; 95% CI: 2.1–5.6; p < 0.001). At six and nine months, 38.2% and 42.5% lacked dietary diversity versus 17.6% and 21.3% of peers (p < 0.01). Gushegu had a feeding difficulty rate of 34.7% versus 24.9% in Nkwanta South (p = 0.03). Travel time had been positively associated with delayed breastfeeding (r = 0.42; p < 0.01). Maternal education (χ² = 12.5; p < 0.001) and birth complications (OR = 2.8; 95% CI: 1.7–4.3) had a significant effect on feeding outcomes. Rural residence (p = 0.02), resource access, and cultural norms were also moderators of feeding outcomes.