Background: Respiratory distress is one of the most common causes of neonatal morbidity and admission to neonatal intensive care units, particularly among term neonates. Although more frequently associated with prematurity, its occurrence in term neonates often signals significant underlying pathology such as infection, meconium aspiration, pulmonary hypertension, or delayed clearance of fetal lung fluid. This study evaluated the clinical profile, etiological spectrum, associated risk factors, and outcomes of respiratory distress in term neonates admitted to a tertiary care center. Methods: This prospective observational study was conducted in the Department of Pediatrics and Neonatal Intensive Care Unit (NICU) of Saraswathi Institute of Medical Sciences, Hapur, over 18 months. A total of 150 full-term neonates (gestational age ≥37 weeks), both inborn and outborn, admitted with respiratory distress (defined as any two of: respiratory rate >60/min, subcostal/intercostal retractions, expiratory grunt) within 7 days of age were consecutively enrolled after informed parental consent. Severity was graded using Downe’s scoring system (mild ≤3, moderate 4–6, severe ≥7). Etiology was established from history, clinical examination, and radiological (chest X-ray) findings, supported by C-reactive protein and blood culture where indicated. Data were analyzed in SPSS version 29.0 using descriptive statistics and the chi-square test, with p