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To investigate the relationship between the expression of serum micro ribonucleic acid (miR)-34b-5p and miR-155 and the inflammatory factors and prognosis of premature infants with acute respiratory distress syndrome (ARDS). 92 premature infants with ARDS who were admitted to our hospital from February 2019 to March 2021 were selected, and they were divided into mild group (31 cases), moderate group (43 cases) and severe group (18 cases) according to the severity of ARDS, follow up the clinical outcome of children, according to the death in hospital, they were divided into survival group (51 cases) and death group (41 cases). The expressions of serum miR-34b-5p and miR-155, as well as interleukin-1 β(IL-1β), tumor necrosis factor -α(TNF-α) and interleukin- 6 (IL-6) in all the children were detected. The differences of the above indexes among the groups were compared, the correlation between the expressions of serum miR-34b-5p and miR-155 and inflammatory factors and the value of miR-34b-5p and miR-155 in predicting the prognosis of premature infants with ARDS were analyzed. The expression levels of serum miR-155 and the levels of IL-1β, TNF-αand IL-6 in the severe group were higher than those in the moderate group and mild group, and those in moderate group were higher than those in mild group (P<0.05). The expression level of serum miR-34b-5p in the severe group was lower than that in moderate and mild groups, and that in moderate group was lower than that in mild group (P<0.05). The expression level of serum miR-155 in the death group was higher than that in the survival group (P<0.05), and the expression level of miR-34b-5p in the death group was lower than those in the survival group (P<0.05). The expression level of miR-155 was positively correlated with the levels of IL-1β, TNF-αand IL-6 in premature infants with ARDS(P<0.05), and the expression level of miR-34b-5p was negatively correlated with the levels of IL-1β, TNF-αand IL-6(P<0.05). The area under curve(AUC) of miR-34b-5p and miR-155 predicting premature infant death in ARDS was 0.853, which was higher than 0.688 and 0.649 predicted by the two indexes alone. The expression levels of serum miR-34b-5p and miR-155 in premature infants with ARDS are related to the levels of serum inflammatory factors and prognosis, which can be used as potential indexes for condition evaluation and prognosis prediction of premature infants with ARDS. [ABSTRACT FROM AUTHOR]