Spontaneous pneumothorax is an uncommon occurrence at birth but when present is one of the few treatable causes of respiratory distress in the newborn. It is often associated with hyaline membrane disease, vigorous resuscitation, and aspiration of meconium-stained amniotic fluid. Grunting, tachypnea, cyanosis, and retraction are chiefly signs and symptoms. We reported on two cases, who both presented with unexplained spontaneous pneumothorax after birth about one day later. Mild L't hydronephrosis was noted on case 1. Poor visualization of the heart on echocardiography was found on both cases during initial evaluation. The literatures are also reviewed.