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This retrospective study conducted at the Tunis Maternity Center over 24 months examined 32 cases of neonatal pneumothorax (PNO) within the first 24 hours of life, with an incidence of 11/1000 live births. Mothers had an average age of 31.7 years, and 40.6% of newborns had a low birth weight. Half of the PNOs were diagnosed before the first hour of life, the main signs being polypnoea, cyanosis and desaturation. Two-thirds of PNOs were right unilateral, and 31.3% of cases were suffocating.Identified risk factors included oligohydramnios, elective caesarean section, and mask ventilation. Management included needle exsufflation (68.8%), chest drainage (56.3%), and mechanical ventilation (62%). The mortality rate was 53.1%, mainly among premature infants. The study underlines the importance of developing national guidelines to reduce the incidence of PNO and improve its management, requiring more nationwide studies.