Neonatal ventilatory requirements and outcome were examined in 135 very preterm, small-for-gestational age (SGA) infants to determine whether fetal growth retardation protects against severe respiratory distress syndrome (RDS) in very immature infants. Their results were compared to those from gestational age- and gender-matched controls. Although there was no significant difference in the median duration of mechanical ventilation between the two groups, more SGA infants required ventilation and were ventilated because of RDS. In a subgroup also matched for mode of delivery, there was no significant difference between the proportion of SGA infants requiring mechanical ventilation for RDS compared to their matched controls. The mortality was greater in the SGA group. We conclude that fetal growth retardation does not protect against severe RDS.