Background: Neonatal respiratory distress syndrome is a major cause of morbidity and mortality, particularly in preterm infants. This condition results from surfactant deficiency and structural immaturity of the lungs, leading to impaired gas exchange. Chest X-ray remains an important diagnostic tool for confirming respiratory distress syndrome and assessing disease severity, especially in resource-limited settings. This study aimed to evaluate the chest X-ray findings in neonatal respiratory distress syndrome and determine the association between gestational age and disease severity. Methods: This cross-sectional observational study was conducted in the Department of Radiology and Imaging, Bangladesh Shishu Hospital, Dhaka, Bangladesh, from June 2024 to July 2025. A total of 110 neonates with clinically suspected respiratory distress syndrome were included. Data were collected prospectively using structured forms to record the demographic characteristics and radiological findings. Chest X-ray images were evaluated to identify characteristic patterns and severity grading. Statistical analysis was performed using SPSS version 25.0. Results: Most neonates were preterm and had a low birth weight. The most common radiological finding was a ground-glass or reticulogranular pattern (83.6 %), followed by an air bronchogram (70.9%) and reduced lung volume (66.4%). Grade II severity was the most frequently observed (37.3%). A significant association was found between gestational age and severity of respiratory distress syndrome (p=0.002), with severe disease being more common in neonates less than 34 weeks of gestation. Conclusion: Chest X-ray demonstrates characteristic radiological patterns that help diagnose and assess the severity of neonatal respiratory distress syndrome. Early identification of imaging features may facilitate timely management and improve the neonatal outcomes.