Objective: to determine risk factors associated with greater severity of HMD. Materials and Methods: analytical component observational case control. Results: a total of 64 patients, 13 (20.3%) with severe HMD, 51 mild and moderate HMD. There was a relationship between premature rupture of membranes, cesarean section without labor, fetal asphyxia, acidosis, and early neonatal infection with the highest requirement surfactant p <0.05. The PMVA required was higher in children of diabetic mothers and newborns with asphyxia, fetal acidosis p <0.05. The mechanical ventilation time was lower in those who received antenatal steroids p <0.05. There was a tendency to present severe HMD in patients with gestational diabetes who had a cesarean delivery without labor started or had a history of third trimester bleeding. Conclusions: there were no significant differences in the variables of gestational diabetes, bleeding in the third quarter and cesarean section without labor, probably because the sample size. Then considered the possibility of further prospective studies linking these factors with the severity of hyaline membrane disease.