Objective: To examine if hypoxia-inducible factor-1 alpha (Hif-1 alpha) polymorphisms are associated with pediatric acute respiratory distress syndrome (PARDS). Methods: Twenty two patients with PARDS and 11 non-PARDS controls were examined in pediatric intensive care unit in Cukurova University Balcali Hospital. Blood polymorphism was used to assess the Hif-1 alpha C1772T and G1790A polymorphisms of Hif-1 alpha gene, and differences in genotypes between the 2 groups were compared. Results: Hif-1 alpha C1772T polymorphism was observed only in one case of PARDS group but non-PARDS group didn't show any C1772T polymorphism. Particularly, the difference in number of cases with Hif-1 alpha G1790A polymorphism was not significant between PARDS and non-PARDS groups. In addition, Hif-1 alpha G1790A polymorphism was significantly related to the distribution of lung opacities in children with PARDS (P<0.05). Conclusions: Our results indicate that Hif-1 alpha G1790A polymorphism is related to an increased susceptibility to pulmonary for PARDS children. The detection of G1790A polymorphism could help pediatricians to predict the extensity of PARDS early in lung tissue.