BACK GROUND Respiratory distress syndrome, formerly known as hyaline membrane disease, is a common problem in preterm infants. This disorder is caused primarily by deficiency of pulmonary surfactant in an immature lung. Characteristically, tachypnea, prominent (often audible) expiratory grunting, intercostal and subcostal retractions, nasal flaring, and cyanosis are noted. Respiratory distress syndrome is a major cause of morbidity and mortality in preterm infants. OBJECTIVES To assess magnitude of respiratory distress related death and associated factors of respiratory distress syndrome among pre term neonates admitted at Tibebe ghion specialized hospital North West Ethiopia from January to August 2022. METHODS A hospital-based prospective followup study was conducted among preterm newborns admitted to Tibebe Ghion comprehensive specialized hospital with the diagnosis of respiratory distress syndrome from January 1, to August 30, 2022. The collected data was coded and checked for completeness, and entered into SPSS version 25.0 for analysis. Descriptive statistics like frequency, mean, and median were used to describe the data. A binary logistic regression method was fitted to identify associated factors. The odds ratio, with a 95% confidence interval, was estimated to determine the strength of association. Variables with Odds ratio having p value <0.05 in multivariable analysis were considered to be as an independent associated factor for the outcome of respiratory distress syndrome. RESULT In the current study, about (42.6%) of neonates were died due to preterm respiratory distress syndrome within 96 hours of age after delivery. Preterm neonates delivered to preclamptic mothers and those from Preterm premature rupture of membrane mothers were the associated factors for respiratory distress related death with (AOR = 0.488; 95% CI: 0.256, 0.929) and (AOR=3.54; 95% CI:1.167, 10.739). CONCLUSION AND RECOMMENDATION From the present study it can be concluded that the death rate of preterm neonatal respiratory distress syndrome was high. Preterm neonate born to preeclamptic mothers and preterm premature rupture of membrane mothers were associated factors that decrease and increase respiratory distress syndrome related death respectively. To decrease the death related to preterm neonatal respiratory distress syndrome, the hospital where the study was conducted should give emphasis on treatment strategies of respiratory distress syndrome, including antenatal corticosteroids, surfactants, and advanced respiratory care of the neonate. Keywords: Respiratory Distress Syndrome, preterm, neonatal mortality, associated factors Bahirdar.