Excluding congenital heart disease, neonatal respiratory distress can be broken down into two broad categories: medical and surgical. Medical causes are managed by the neonatologist. Surgical causes need the immediate care of a pediatric surgeon because of mass effect on the developing lungs and possible acute airway compromise. Congenital heart disease is suspected when external oxygenation does not raise the oxygen saturation. The oxygen saturation will respond to external oxygenation if lung disease is the cause.