Introduction: Critically ill children require treatment in an intensive care unit which is not easily available in rural areas and costly resulting in more deaths in rural parts of India. The knowledge of pattern of disease prevalent in the local community plays an important role in planning appropriate health care facilities. Outcome findings help in evaluation of current medical practices and carrying out changes if necessary, leading to better patient care.Objectives: To analyse morbidity pattern and outcome in patients admitted in a Paediatric Intensive Care Unit (PICU) of a hospital in rural Maharashtra.Method: Descriptive data were collected retrospectively from the hospital medical records from January 2017 to December 2018 and analysed for morbidity pattern and outcome in children admitted in the PICU.Results: A total of 2386 children were admitted and treated in the PICU during the 2-year period. Mean age of the studied patients was 40.2 ± 42 months; 34% were infants and 58.9% were males. The mean length of stay (LOS) in PICU was 4.81 ± 4.89 days. Diagnoses included respiratory infection (27.3%), infectious diseases (20.5%), neurological disorders (18.2%), gastrointestinal (10.5%), haematological (5.8%), renal/endocrinal (3.2 %), cardiovascular (3.1%), and others (10.7%). Other causes included acute poisoning, snake / scorpion bite, trauma and foreign body ingestion / aspiration. The overall mortality rate was 9%.