It is also known as hyaline membrane disease, which is an immature fetal lungs having a deficiency in surfactant, reduced surfactant results in low lung compliance and subsequent atelectasis, intrapulmonary shunting, and acute lung injury. The causes are prematurity (most important) of type II pneumocytes (the normal source of surfactant production), Cesarean section (lack of vaginal compression stress on the infant during delivery results in reduced fetal cortisol production and result in reduction in surfactant production), and maternal diabetes (high insulin levels decrease surfactant production).