First breath is the most vital parameter in the beginning of a new life. Respiratory distress is a challenging problem and one of the most common cause of admission for neonatal intensive care unit (NICU) in both term and preterm infants1. Most of the causes of neonatal morbidity and mortality are preventable. Incidence of respiratory distress depends on various factors like gestational age, low birth weight, perinatal infections, and complications during pregnancy2. In a neonate, clinical diagnosis of respiratory distress is suspected if the respiratory rate is greater than 60 per minute in a quite resting baby, presence of grunting and/or there are inspiratory subcostal/intracostal retractions3. Presence of grunting, nasal flaring, retractions, tachypnea, decreased breath sounds are the important signs of respiratory distress4. Even in healthy term infants, oxygenation is impaired immediately after birth, and oxygen saturation gradually increases and exceeds 90% only at about 5 min5.

The severity of respiratory distress can be assessed by Downe’s scoring system6 and Silverman Anderson scoring system7. Respiratory distress syndrome, transient tachypnea of neonate, pneumonia, pneumothorax and air leaks, congenital pneumonia, Meconium aspiration syndrome, Tracheo-esophageal fistula, Diaphragmatic hernia are the important causes of respiratory distress in neonates8.

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Other uncommon respiratory causes include congenital lobar emphysema, accessory or