This is a case of a patient with respiratory distress syndrome that underwent endotracheal intubation. The patient presents with decreased breath sounds on the right lung field as well as a mediastinal shift to the left (contralateral side) manifested by the shift of PMI from the normal midclavicular line to axillary line. This is a case of pneumothorax, considering the salient features of the case, since endotracheal intubation poses a risk factor especially in neonates to develop pneumothorax.