Background: In the developing world, morbidity and mortality in under-five year old children is an important public health problem. Paediatric intensive care unit (PICU) is set aside for managing children with life-threatening illnesses. There is increased survival of critically ill children, with advances in intensive care facilities. Outcome depends on the underlying nature of the disease, associated co-morbidities, clinical condition of the patient at presentation, infrastructure and the quality of care provided in the unit. Objective: To examine pattern and clinical outcome of patients admitted in the pediatric intensive care unit. Methods: This is a prospective observational study conducted in Pediatric Intensive Care Unit (PICU) of-Bangladesh Shishu Hospital and Institute, Dhaka, Bangladesh from January to December 2021. All patients from age of 1 month to 18 years admitted to PICU meeting the inclusion criteria are included in the study. PICU records of all admissions, transfer out, discharges and deaths were used for this study. Data used from the records included age, sex, diagnosis, and outcome of all the patients admitted to PICU. The outcome is classified as transfers to pediatric wards, discharges, patients who left against medical advice (LAMA), and deaths. Results: Total of 431 patients were admitted into PICU. (201) 46.6% were infants, and (230) 53.4% patients aged 1-18 years. Their ages ranged from one month to 18 years, with the mean age being 40.01 ± 45.79 months. There were 264 (61.3%) male and 167 (38.7%) female patients giving an M: F ratio of 1.58:1. The most common cause of admission was respiratory 195 (45.2%), infectious 107 (24.8%), surgical 31 (7.2%), cardiovascular 21 (4.9%), neurological 45 (10.4%), haematological 12(2.8%), renal 04 (0.9%) and others 16 (2.7%). Disorders needing surgical intervention were the commonest condition in children of all age groups. The overall mortality rate was 22.5%. Ninety Seven (22.5%) patients died during the period, consisting of 53 (54.6%) males and 44 (45.4%) females, with their mean age being 53.71 months (range, one month to 18 years). 40 (41.2%) of Respiratory dysfunction, 23 (23.7%) of cardiovascular disorders, 12 (12.4%) of neurological problems, 5 (5.2%) of Haematological disfunction, and 17 (17.5%) patients died in the postoperative period. Conclusions: Diseases including infections were the predominant conditions leading to PICU admissions in our setting. In our PICU, mortality is low. Most of the deaths were serious illnesses with poor prognosis that require adequate medical knowledge, facilities, equipment and infrastructure. This forms a major challenge in Low and Middle Income Countries (LMIC). We advocate a focus on continuous development within the sphere of influence. This highlights the importance of addressing critically ill children and expanding intensive care facilities in the region