A prospective unmatched case-control study of 256 neonates with Respiratory Distress Syndrome (RDS) and 256 controls was conducted to study risk factors and outcome during March to November 1995. RDS contributed to 6 per cent of all neonatal admissions and was significantly associated with lower birthweights, gestational age, birth asphyxia and male sex. Maternal hypertension with or without albuminuria (EPH gestosis) was inversely related to RDS. There was no significant association between RDS and mode of delivery, antepartum haemorrhage or premature prolonged rupture of membranes of more than 24 h. A total of 134 (52 per cent) neonates with RDS died, 88 per cent of which occurred in the first 7 days of life, thus contributing to perinatal mortality. Expiratory grunting was significantly associated with increased mortality among infants with RDS.