The objectives of this work were to determine the rate, risk factors, and outcome of ventilator- associated pneumonia in pediatric intensive care unit (PICU) and to evaluate a clinical score: clinical pulmonary infection score (CPIS) in diagnosing ventilator- associated pneumonia in early stages. A prospective cohort study was conducted at the PICU of Cairo University Pediatric Hospital through a year. CPIS was applied at days 1, 3, 7 and 10 from ventilation. There were 11 episodes of ventilator- associated pneumonia in 26 patients (42.3%). The mean ventilator associated rate was [31.16/1000] ventilation days. Bacteremia, lung disease, multiple central venous catheters and re-intubation were independent risk factors for ventilator- associated pneumonia. It has been found that CPIS score was not always useful for diagnosis of ventilator- associated pneumonia in children. The most common causative agents of VAP were Pseudomonas aeruginosa, Enterobacteriaceae and klebsiella pneumoniae. Further evaluation of the CPIS is needed in a wide sample scale.