Background: Respiratory distress is one of the most common problems in the first few days of life. Respiratory distress is a symptom complex that represents a heterogenous group of illness with varying incidence, etiology, clinical picture and outcome. In newborn infants, it may be due to either pulmonary or extra pulmonary causes. Aim of the work: The aim of this study is to assess the causes of respiratory distress in neonates admitted to the neonatal intensive care unit at Benha University Hospital. Patients and methods: This comparative cross-sectional study was carried out on all the neonates admitted in the NICU of the pediatric department at Benha University Hospital during the first 28 days of life, belonging to either gender and with gestational age more than 28 weeks and weight more than 1000 gram. Results: The present study showed that, 23.8% of NICU patients had respiratory distress. Regarding the diagnosis, transient tachypnea of the newborn (TTN) was present in 26% of the patients then meconium aspiration syndrome (MAS) and severe respiratory distress syndrome(RDS) (16% for each) then bronchopneumonia and moderate RDS (8% for each) . Conclusion: Our study revealed that 23.8% of NICU patients had respiratory distress. TTN and MAS were the most frequent causes