Background. Respiratory distress syndrome(RDS) of the newborn is caused by pulmonary surfactant deficiency in the lungs of neonates wh ich leads to alveolar collapse and noncompliant lungs. It can be primary or secondary, due to meconium aspiration or Group B Streptocoocus (GBS) infection. RDS is usually diagnosed with a combination of clinical signs and/or symptoms (apnea, cyanosis, grun ting, inspiratory stridor, nasal flaring, poor feeding, and tachypnea), chest radiographic findings, and arterial blood gas Results. In near term or term infants with great respiratory effort, RDS can be complicated with spontaneous pnumothorax. Case report. A 2700 g male neonate was admitted to the neonatal intensive care unit (NICU) of Mures County Emergency Hospital with respiratory distress syndrome. Baby was vaginal born at a gestational age of 39/40 weeks at Ludus Emergency Hospital. Apgar score was 10/10 at the 1 min and 5 minutes respectively. The patient developed respiratory distress syndrome in the first few hours. He had inter and subcostal retractions, grunting, tachypnea (80 breaths per minute), nasal flaring and the pulse was 127 beats p er minute with a SpO2 under 90% in room air and higher than 95% with oxygen supplementation. The treatment with Dexamethasone showed no improvement and an urgent Chest X ray was ordered which revealed a left pneumothorax with mediastinal shift to the oppos ite site. ABG revealed severe acidosis. (pH 7.13, PCO2 70, PO2 46 mmHg). In view of impending respiratory failure and shock baby was intubated, the pneumothorax was drained. Hemoculture was positive with GBS. The antibiotic therapy (Ampicillin/Sulbac tam and Amikacin) was started and the patient was carefully monitored. Conclusions. In conclusion, although respiratory distress syndrome is rare in near term or term newborn, is usually secondary to a parenchimal pathology, being a common case of spontan eous pneumothorax in these infants. Early recognition and treatment is life saving. Usual manifestation is progressive respiratory difficulty starting soon after birth.