Introduction: Neonatal Respiratory Distress (NRD) is the most frequent reason for admissions to NICUs. Studies on this topic are limited in our setup and mostly focused on finding the incidence of NRD. The aim of this study was to find the incidence and the most common causes of neonatal respiratory distress in our setting to better prepare treatment protocols and improve overall outcomes. Methodology: A cross-sectional study was conducted in a tertiary care medical college hospital from February 2022 to October 2022. Data of all neonates admitted with respiratory distress during this term was collected and analyzed. Results: A total of 550 neonates were admitted to the NICU out of which 207(37.6%) developed respiratory distress. The most common cause of NRD was Respiratory Distress Syndrome 129 cases (62.3%) followed by Pneumonia 25 cases (12.1%), Birth Asphyxia 21 cases (10.1%), and Sepsis 17 cases (8.21%). The highest mortality was observed in cases with RDS (8.35%). Conclusion: The study highlights the importance of NRD which has a high incidence rate in NICUs and a mortality rate of 7.2%. The most common causes are also preventable and treatable, and suggestions have been made to help reduce incidence and mortality and improve outcomes.