Introduction: Neuroblastoma (NB) is one of the most common malignant extracranial solid tumors in children, mainly detected in children between the ages of 22 months to five years. It can develop in any location of the sympathetic nervous system. Although it has a broad spectrum of signs and symptoms, it is hard to find cases with major respiratory manifestations. Case Presentation: Our case report presents a 50-day-old male admitted to a local hospital with respiratory distress and cyanosis. Then, he was intubated and transferred to our pediatric center for further evaluation. Our investigation found a mass in the mediastinum with lung involvement. This patient is a rare case of neuroblastoma that occurred earlier in the age of onset with uncommon respiratory manifestation, unresponsive to outpatient treatment. Conclusions: We presented a neuroblastoma case with persistent respiratory manifestations that repeatedly received outpatient treatment for respiratory diseases, but his condition did not improve. Physicians should always suspect this condition in addition to other differential diagnoses, especially in patients unresponsive to outpatient treatment, with abnormal chest X-rays and respiratory symptoms.