Abstract Background: The pattern of pediatrics surgical admission at zonal hospital is poorly documented in developing coun-tries. This poor documentation usually makes difficult to analyze the mortality, morbidity and factors affecting the outcomes of these surgical problems. Aim of Study: The aim of this study is to analyze the pattern of admissions of children at the first decade of life at pediatric surgery units for elective and emergency cases at our referral hospital in one year duration. Patients and Methods: This prospective study was includ-ing all admissions of children at the first decade of life into the pediatric surgical unit either elective or emergency cases from 1st of January 2019 to 1st of January 2020 at one of biggest referral hospital in Egypt. All data was collected from the individual patient medical records which obtained from pediatric surgery and emergency unit. Results: The total admissions of children at the first decade of life to pediatric surgical wards at our referral hospital were 2575. The Emergency cases (1195 cases) were classified into traumatic and non-traumatic cases, While, elective and out-patient cases were 1380 (53.5%) and 580 of them presented with congenital anomalies. We classified our outcome into discharged (92.1 %), died (4%) and Discharged Against Medical Advice (DAMA). Conclusions: Lack of data and poorly documented infor-mation affects proper monitoring of performance and outcome of pediatric surgical cases in developing countries. However, our mortality rate was lower than other studies in developing countries, the presence of specialized well trained staff and well equipped hospital for pediatric surgery will help in decreasing the mortality rate more and more.