Abstract: Objective To investigate the effects of noninvasive transcutaneous blood gas+postural management+protective ventilation intervention for neonatal respiratory distress syndrome (NRDS) on matrix metalloproteinase-16 (MMP-16), Claudin-18, and Clara cell secretory protein 16 (CC16) in children, and to analyze the correlation between the above indicators and bronchopulmonary dysplasia (BPD). 
Methods A total of 106 neonates with NRDS were selected prospectively for the study, and all children received noninvasive transcutaneous blood gas+postural management+protective ventilation intervention. The changes of MMP-16, Claudin-18, and CC16 in neonates were observed before and after intervention. The incidence of BPD in neonates was calculated within two weeks of intervention, and children were divided into BPD group and non-BPD group, to analyze the relationship between MMP-16, Claudin-18, CC16 and BPD. 
Results After intervention, MMP-16 levels were lower than those before intervention, while Claudin-18 and CC16 levels were higher than those before intervention (P＜0.05). BPD occurred in 57 of 106 children with NRDS, accounting for 53.77%. Compared with the non-BPD group, MMP-16 levels were higher and Claudin-18 and CC16 levels were lower in the BPD group (P＜0.05). By point-biserial correlation analysis, the results showed that MMP-16 was positively correlated with the occurrence of BPD (r=0.542, P＜0.05), and Claudin-18 and CC16 levels were negatively correlated with the occurrence of BPD (r=-0.526, -0.639, P＜0.05). By logistic regression analysis, the results showed that MMP-16 was a risk factor for the complication of BPD in children with NRDS (OR＞1, P＜0.05), and Claudin-18 and CC16 were protective factors (OR＜1, P＜0.05). Receiver operating characteristic (ROC) curve was drawn, which showed that the area under the ROC curve (AUC) of MMP-16, Claudin-18 and CC16 for the assessment of BPD in children with NRDS was all ＞0.7, showing assessment value. The value of the combined assessment was higher （AUC=0.902）. 
Conclusion Noninvasive transcutaneous blood gas+postural management+protective ventilation can improve the reduction of MMP-16 levels and increase Claudin-18 and CC16 levels in children with acute respiratory distress syndrome, and the changes of the above three indexes are closely related to the occurrence of BPD. 

Key words: respiratory distress syndrome, neonates, blood gas monitoring, transcutaneous, posture