Ninety six patients with respiratory distress were admitted in NICU. 62 (64.5%) were males, 34 (35.4%) were females. 33 (34.3%) had more than 34 weeks gestation age, 63 (65.6%) had less than 34 weeks gestation age. 44 (45.8%) newborn had <1500 gram body weight, 52 (54%) newborn had >1500 gram body weight. Clinical manifestation were 30 (31.2%) had nasalflaring, 24 (25%) had chest in drawing, 14 (14.5%) had cyanosis, 12 (12.5%) had grunting, 9 (9.3%) were lethargic & 7 (7.2%) had hypothermia. The etiology was 20 (20.8%) had HMD, 17 (17.7%) had BA, 15 (15.6%) had MAS, 13 (13.5%) had TEF, 5 (5.2%) had CHD, 9 (9.3%) had TTN, 11 (11.4%) had Pneumothorax & 6 (6.21%) were Anemic. 21 (21.8%) had vaginal delivery, 59 (61.4%) had elective caesarian, 16 (16.6%) had emergency caesarian. Among the culture positive (39) common organism observed were Kleibesella 16 (41%), Pseudomonas 23 (23.9%), E-coli, 19 (19.7%), S.auresis 12 (12.5) and CONS. Apart from antibiotics neonates were treated - 39 (40.6%) with oxygen, 27 (28.1%) with mechanical ventilator, 21 (21.8%) withcontinuous positive airway pressure, 7 (7.2%) with surfactant  & 2 (2%) with surgery. The discharge profile of neonates was, in 20 HMD cases 5 (25%) had deaths, in 17 BA 3 (17.6%) had death, in 15 MAS 2 (13.3%) had deaths, in 13 TEF 3 (23%) had deaths in 5 CHD, 1 (20%) had death, in 11 Pneumothorax 2 (18.1%) had deaths & in 6 anemic 2 (33.3%) had death. This practical approach to neonates with respiratory distress of different etiologies to cure will be quite helpful to guide theNeonatalogists, Pediatrician, Microbiologists and hospital personnel to handle such neonates efficiently and avoid morbidity and mortality as there is high mortality rate in neonates globally because of ambiguous clinical manifestations.

Keywords: Neonates; North Karnataka; Respiratory distress; Gestational age.