Background: Acute respiratory distress syndrome is defined as acute diffuse inflammatory lung injury causing increased pulmonary vascular permeability with increased lung weight, loss of aerated lung tissues leading to hypoxemia and bilateral radiographic opacities associated with increased venous admixture, increased physiological dead space and decreased lung compliance. Aim of work: to determine the prevalence rates of respiratory distress syndrome (RDS) in neonates in King Abdulaziz Hospital, Taif city, Saudi Arabia and to find out the most important causes of RDS in preterm babies in Taif city. Methods: a cross-sectional questionnaire based study carried out in Saudi Arabia, Taif city, King Abdulaziz Hospital from January to June 2016 (6 months period) on preterm neonates. Results: 57.1% of newborn were male gender and 42.9% were female, 4.4% of babies were extreme preterm, 86.5% were preterm, 4.4% were late preterm and 4.7% were full term, the prevalence rate of RDS in newborn was 54.7% in the 6 months of this study. Conclusion: RDS is one of the major problems among newborns and a major reason for increased morbidity and mortality among infants. Preterm babies are the main risk factor for development of RDS. Mother's illnesses, especially hypertension and Diabetes are very strong risk factors for the disease in preterm babies. Cesarean delivery, especially in preterm babies and male gender stays other important risk factors for RDS.