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Research Snapshot Theater: Epidemiology - Outcomes, Pediatric I

Pediatric Critical Illness in Intensive Care Units in Resource-Limited Settings: A Systematic Review

Sunday, March 22, 2026
9:45 AM - 10:45 AM Central Time
Location: Connections Central - RST 17
Introduction: Most of the childhood morbidity and mortality around the world occurs in low and middle-income countries (LMICs) – regions that also face the most significant resource constraints. Yet, estimates of the burden of pediatric critical illness that can inform effective resource allocation in resource limited settings, are lacking in these regions. The aim of this study was to determine the mortality rates and the leading causes of ICU admission and death among children admitted to intensive care units (ICU) in LMICs.


Methods: We performed a systematic review of studies published between January 2005 – July 2024 in English, Spanish, and French across PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, WHO Global Index Medicus. Eligible studies reported ICU admissions and/or causes of mortality among children 1 month-18 years in ICUs in LMICs. Extracted data included mortality rates, causes of ICU admission and death and were presented by countries classified based on global burden disease 2021 Socio-Demographic Index (SDI).


Results: We identified 39,764 eligible studies. After removing duplicates and screening abstracts, 1,808 full texts were reviewed and 258 studies met inclusion criteria, representing 230,774 pediatric ICU admissions across 35 LMICs. 121 studies (47.7%) were conducted in middle-income countries, 111 (42.4%) in low-middle-income countries, and 26 (9.9%) in low-income countries. Among 222 studies (201,456 admissions) that reported causes of admission, the most common were respiratory (22.3%), neurological (6%), and septic shock (5.6%), with infectious etiologies being most prominent within each system. Mortality data were reported in 190 studies (151,267 admissions ) , with 14,306 ICU deaths, yielding an overall mortality rate of 9.5% (26% in low SDI countries; 16% in low-middle SDI; 6% in middle SDI). The most reported causes of death, overall, were septic shock, pneumonia and pulmonary hemorrhage. Patterns of causes of admission and mortality varied by SDI.


Conclusions: This study highlights that septic shock and respiratory and neurologic conditions are the primary drivers of pediatric ICU admission and mortality in LMICs. Focusing critical care resources on support for these conditions may improve morbidity and mortality in critically ill children in resource-limited settings.