Objective: The aim of this study is to investigate the relationship between the time interval from onset of respiratory distress after birth to decision to refer neonate for transport, and the duration of mechanical ventilation after neonatal transport.

 Methods: This retrospective study analyzed cases of neonatal transport due to respiratory distress from local obstetrical clinics to St. Mary’s Hospital’s neonatal intensive care unit between January 2020 and February 2022. Patients who received respiratory support for less than three days were classified as the short-term respiratory support group, while those who received respiratory support for three days or more were classified as the long-term respiratory support group.

 Results: A total of 89 patients were admitted, consisting of 67 patients in the short-term respiratory support group and 22 patients in the long-term respiratory support group. The median time from onset of respiratory distress to decision to refer patient for neonatal transport was significantly longer in the long-term respiratory support group （9 hours 27 minutes）than in the short-term respiratory support group（1 hour 59 minutes） （p = 0.007）. There were 29 cases where time from onset to referral decision was equal to or greater than 8 hours. Among these 29 cases, the majority of referral decisions（24 cases or 82.8%）were made during the day shift.

 Conclusion: The group of neonates requiring long-term respiratory support had more cases with a longer time to referral decision. Moreover, it was suggested that the longer times until referral were related to the work shift.