Background: Respiratory distress is the leading cause of neonatal intensive care unit (NICU) admission, particularly among preterm neonates due to structural and biochemical lung immaturity.

Objectives: To evaluate the epidemiological profile, maternal and perinatal risk factors, aetiology, and respiratory support requirements of preterm neonates presenting with respiratory distress.

Methods: A prospective hospital‑based cross‑sectional study was conducted in the NICU of KVG Medical College from August 2023 to July 2024 including 42 preterm neonates (<37 weeks gestation) with respiratory distress. Maternal and neonatal data were collected and analyzed using SPSS v25.

Results: Late preterm neonates constituted 79% of cases. Low birth weight infants accounted for 57% and very low birth weight for 26%. Caesarean deliveries were 80.95%. Major causes were transient tachypnea of newborn (45.23%) and respiratory distress syndrome (42.85%). Oxygen therapy via nasal prongs (54.76%) and continuous positive airway pressure (38.05%) were the most common respiratory supports.