The aim of this study was to determine if increased antenatal steroid usage might account for the apparent protective effective of preterm premature rupture of the membranes (PPROM) against neonatal respiratory distress. Comparison was made of the outcome of 36 preterm infants consecutively admitted to the neonatal unit whose mothers had PPROM (study patients) and 36 matched controls whose mothers had intact membranes. The control infants were matched for gestational age at delivery, gender, mode of delivery and approximate date of birth. We found that significantly more study patients had received antenatal steroid therapy, 14 or 36 compared to five of 36 controls, p < 0.03. The study group tended to require a shorter duration of mechanical ventilation and a lower maximum inspired oxygen concentration. However, when matched infants were compared, neither of whose mothers had received antenatal steroids, this trend was reversed with the study patients requiring more respiratory support. We conclude these results suggest that increased antenatal steroid usage may account for the apparent protective effect of PPROM against the development of neonatal respiratory distress.