Background: Neonatal respiratory distress remains a significant clinical challenge, contributing to substantial neonatal morbidity and mortality worldwide. This review explores the multifactorial etiology, pathophysiology, diagnostic approaches, and management strategies for neonatal respiratory distress. Common causes such as respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN), meconium aspiration syndrome (MAS), pneumonia, and congenital anomalies are discussed in detail. The article highlights advances in diagnostic modalities, including bedside lung ultrasound and blood gas analysis, which have improved early detection and differentiation of underlying causes. Furthermore, evidence-based therapeutic interventions, such as surfactant replacement therapy, non invasive ventilation strategies, and the role of antenatal corticosteroids, are reviewed. Emphasis is also placed on the importance of a multidisciplinary team approach in optimizing outcomes for neonates with respiratory distress. Future directions, including emerging therapies and ongoing research, are explored to address existing gaps in knowledge. This review aims to provide clinicians and healthcare professionals with a comprehensive understanding of neonatal respiratory distress to enhance early recognition, effective management, and improved neonatal outcomes.