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Abstract Background: An excessive production of free radicals contributes to an increased burden of oxidative stress that may be implicated in the pathophysiology of tissue injury of various organs and in systemic dysfunction in critically ill patients. Objectives: To evaluate oxidants and antioxidants levels in critically ill pediatric patients. Patients and Methods: The study included 50 pediatric patients; 25 critically ill and 25 control. All patients were subjected to detailed medical history, thorough clinical examination. The degree of critical illness was assessed according to qSOFA score. Laboratory investigations included complete blood count, malondialdehyde (MDA) as an index of lipid peroxiadation, total antioxidant capacity (TAC) and paraoxonase-1as an index of antioxidants level. Results: there was statistically significant increase in the level of Serum MDA and TAC in ICU patients than control with p-value < 0.001 and < 0.001 respectively, and decrease in serum paraoxonase-1in cases than control with p-value < 0.001. TAC was significant increased in patients with septic shock p-value = 0.042. Positive significant correlation between MDA and AST (p-value= 0.015,r= 0.481), TAC and AST (p-value= 0.005, r= 0.542) and TAC and INR (p-value= 0.042, r= 0.409) |