Introduction: Respiratory distress is the most significant cause of neonates in need of resuscitation and neonatal intensive care unit admission. It is one of the leading causes of early neonatal mortality, mainly in middle-and low-income countries. Besides this fact, time to death and its predictors among neonates with respiratory distress are not addressed. Objective: To assess time to death and predictors among neonates admitted with respiratory distress at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia, 2022. Methods and materials: An institution-based retrospective follow-up study was employed among 475 records of neonates admitted with respiratory distress at Felege Hiwot comprehensive specialized Hospital from January 2019 to December 2021. Data was extracted from neonatal records after being selected through a simple random sampling technique. Data was entered into Epi-data before being exported to Statistical and Data Version 16. A failure probability table and the Kaplan-Meier failure function were computed. The assumption was checked by Schoenfeld residual test. A Weibull regression model was fitted to identify predictors of time to death among neonates admitted with respiratory distress. All variables in the bivariable analysis with p-values less than 0.15 were included in the multivariable Weibull regression model. The hazard ratio with a 95% confidence interval was reported and statistical significance was declared at a p-value of 0.05. Results: The mean time to death of neonates with respiratory distress was 5.34±0.162 days. Of all deaths, 90% of death occurred within 7 days during the follow-up and the overall incidence rate was 54 deaths per 1000 neonate days from diagnosis with respiratory distress. Being male (AHR: 1.64, 95%, CI: 1.08,2.50), birth weight <2500 gram(AHR: 1.9, 95%, CI: 1.06), 3.27, not cry at birth (AHR: 2.7, 95%, CI: 1.56, 4.50), preterm (AHR: 2.42, 95%, CI: 1.33, 4.40), obstetric complications (AHR: 1.96; 95%, CI: 1.20, 3.13) and referred neonates (AHR: 1.82; 95%, CI: 1.10, 3.01) were predictors of time to death Conclusion and recommendations: The risk of death was higher during the early neonatal period. Sex of the neonate, birth weight, not crying at birth, preterm, obstetric complications, and source of referral were predictors of time to death for neonates with respiratory distress. As soon as the diagnosis is set, it is better to transfer to a neonatal intensive care unit for better management. Keywords: Respiratory distress, Time to death, predictors, Neonate, Ethiopia