Respiratory distress is one of the most common causes of neonatal intensive care unit admittance. In the whole newborn period the incidence is 7%, but is becoming more common and is even more common in premature babies. Fifteen percent of babies admitted to neonatal intensive care unit and 29% of late preterm infants develop significant airway morbidity. Respiratory distress in newborn is considered as an increase in one or more following factors designating increased respiratory effort; tachypnea, runny nose, nasal flaring, retraction or grunting. The causes of respiratory distress in the newborn are diverse and multi-systemic. Pulmonary causes may be associated with changes in normal lung development or during extra uterine life. The underlying cause of respiratory distress varies in the newborn and is not always caused by respiratory system. It is therefore important to use a detailed history, physical examination, radiographic and laboratory findings to determine a more specific diagnosis and appropriate management after initial resuscitation and stabilization. Understanding respiratory distress in newborn is easy and understanding physiological abnormalities associated with each of the various causes will guide the optimal management.