Abstract: Objective To investigate the incidence and risk factors of neonatal respiratory distress syndrome（NRDS） in twin pregnancy. Methods The clinical data of 222 pairs（444 cases） of live twin newborns hospitalized in the Department of Neonatology of Xiaogan Hospital Affiliated to Wuhan University of Science and Technology from January 2017 to December 2021 were analyzed retrospectively，including 51 pairs of twins（102 cases）(both with NRDS)(group A)，39 pairs of twins（78 cases）(one with NRDS)(group B ) and 132 pairs of twins（264 cases）(without NRDS)(group C).The general data of newborns and the incidence of NRDS in the three groups were compared. Results (1) Univariate analysis showed that there were significant differences in gestational age and birth weight between group A/group B and group C(P<0.001). There was a statistically significant difference in prenatal corticosteroid use between group A/group B and group C(P<0.001). The ratio of Apgar score ≤7 in 1 min between group A/group B and group C was statistically significant(P<0.001).（2）Taking group C as the control group，the gestational age，birth weight and prenatal corticosteroids use were included to construct a multivariate logistic regression equation. The results showed that twins with small gestational age，1 min Apgar score ≤7 and no prenatal use of corticosteroids were more likely to suffer from NRDS.Conclusion Twins with small gestational age，no prenatal use of corticosteroids and 1 min Apgar score ≤7 are more likely to develop NRDS. There are differences in NRDS between twins，which is related to gestational age and 1 min Apgar score ≤7.Therefore，prenatal use of corticosteroids should be standardized to prevent asphyxia;select appropriate delivery time and mode，to reduce the occurrence of NRDS.Conclusion Twins with small gestational age，no prenatal use of corticosteroids and 1 min Apgar score ≤ 7 are more likely to develop NRDS.There are differences in NRDS between twins，which is related to gestational age and 1 min Apgar score ≤7.Therefore，prenatal use of corticosteroids should be standardized to prevent asphyxia，select appropriate delivery time and mode，and reduce the occurrence of NRDS.

Key words:

Neonatal respiratory distress syndrome, Twins, Risk factors