A hospital-based case-control study was conducted to examine the relationship between hyaline membrane disease (HMD) and caesarean route of delivery, in light of sociodemographic, obstetric and perinatal confounders and risk modifying factors. The study population consisted of 78 HMD cases and a control group of 803 infants delivered at 25-36 weeks' gestation and admitted over a 16-month period to nine hospitals in Greater Beirut, Lebanon. The likelihood of delivery by caesarean section was nearly twice as high among newborn infants diagnosed with HMD as compared with the non-HMD control group (OR = 2.02, [95% CI 1.04, 3.92], after adjusting for fetal growth ratio, one-minute Apgar score, maternal age, antenatal steroid administration and pregnancy-related complications. The impact of caesarean section on HMD was considerably more important in infants delivered < or = 32 weeks' gestation (OR = 2.10, [95% CI 0.79, 5.52]) as compared with those delivered afterwards (OR = 1.13, [95% CI 0.40, 3.21]).