Background: Pleural effusion is the most common presentation of pleural diseases. It can be caused by a variety of conditions including pleuro-pulmonary pathology or systemic disorders. This study aimed to determine incidence, causes and outcome of pleural effusion in pediatric intensive care unit (PICU). Methods: This observational study was conducted on 24 children of age 1 month to 16 years with pleural effusion admitted to PICU. All cases were subjected to full history taking, complete clinical examination and investigations including analysis of pleural effusion, Chest x- ray and computed tomography (CT) chest. Results: During the period of the study from March 2024 to February 2025, 550 patients were admitted to PICU, 24 of them had pleural effusion (4.3%), 13 males and 11 females, their mean age was 6.1±3.7 years, 66.7% of children had exudates, 29.2% had transudate, only 4.1% had hemorrhagic effusion. About 50% had empyema 12.5% had para-pneumonic effusion, 4.2% had ruptured hydatid cyst, 20.8% of cases had congestive heart failure, 4.2% had para-pneumonic effusion and 4.2% had nephrotic syndrome. most cases needed noninvasive oxygen support (79.2%), only 20.8% of cases needed mechanical ventillation (MV). Most cases (70.8%) had thoracostomy, 16.7% had diagnostic tapping while 12.5% had no intervention. Most cases (58.3%) were discharged home without complications, 20.8% had decortication, 12.5% needed STK injection, 4.2% had lobectomy + decortication, and 4.2% of cases didn't survive. Conclusion: Pleural effusion became more common in children. Majority of effusion occured in younger children and were exudative in origin. Proper diagnosis and prompt treatment ensued an excellent prognosis.