Objective To investigate the relationship between premature rupture of membranes (PROM) combined with chorioamnionitis and neonatal respiratory distress syndrome (NRDS) in very preterm infants (VPIs). Methods Medical records of newborns with gestational age < 32 weeks in a neonatal intensive care unit (NICU) from June 2016 to June 2019 were retrospectively analyzed, according to whether the pregnant mother had PROM, newborns were divided into control group and PROM group, PROM group was subdivided into PROM with chorioamnionitis group (PROM infection group) and PROM without chorioamnionitis group (PROM non-infection group).Clinical data of three groups of VPIs was compared, effect of chorioamnionitis after PROM on the occurrence and development of NRDS was explored. Results A total of 284 preterm infants were included in study, 136 were in control group, incidence of NRDS was 74.3%(n=101);97 cases were in PROM non-infection group, incidence of NRDS was 68.0%(n=66);51 cases were in PROM infection group, incidence of NRDS was 82.4%(n=42);there was no significant difference in the NRDS incidence between VPIs in PROM non-infection group and control group (χ²=1.080, P=0.299);there was significant difference in NRDS incidence between VPIs in PROM infection group and PROM non-infection group (χ²=3.471, P=0.062).The severity of NRDS was compared through gastric foam test, pulmonary surfactant (PS) use times, ventilator use and chest radiography re-examination result after PS use, the results showed that disease condition of NRDS in VPIs in PROM non-infection group was milder, and the invasive ventilator use rate was lower (26.0%); after PS use, the proportion of no-NRDS in chest radiography re-examination was higher (88.0%) in VPIs in PROM non-infection group, and there was no severe NRDS; the proportion of severe NRDS in chest radiography re-examination in PROM infection group was still higher (9.5%), multiple use of PS was necessary, and the use rate of invasive ventilator was the highest (73.8%). Conclusion PROM combined with chorioamnionitis may be a risk factor for NRDS, which may affect the progression and prognosis of NRDS.