Objective: To evaluate the causes of respiratory problems in premature neonates admitted to Elmonira hospital NICU during the year 2007 as regards their incidence, management, complications and mortality. Methods: It is a retrospective study conducted on 106 preterm neonates with respiratory distress admitted at NICU of Children Hospital, Cairo University over one year started from January- end of December 2007. All records of premature neonates presented by respiratory problems were reviewed and the following data were collected; gestational age, birth weight, sex, mode of delivery, maternal illness, antenatal steroids, complications and outcome. Results: RDS was the commonest respiratory problems (49.1%) followed by pneumonia (26.4%).SIMV was the main method of oxygen support (71.7%). Pneumonia (21.7 %) and pneumothorax (16 %) were the main complications with significant difference regarding gestational age and birth weight . Mortality rate was (58.5%) with statistical significant difference with age, gestational age, birth weight and blood gases results of the studied neonates. Conclusions: RDS and pneumonia are inversely related to gestational age and birth weight. Mortality was high in preterm neonates with respiratory problems.