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Objectives
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To determine in critically ill children: 1) when upper gastrointestinal bleeding (UGIB) and clinically significant UGIB (CS-UGIB) occur; 2) the mean incidence density and the cumulative incidence of UGIB and CS-UGIB.

Design
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Prospective epidemiological study.

Site
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Multidisciplinary pediatric intensive care unit (PICU) in a tertiary care teaching hospital.

Methods
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UGIB was considered to be present if hematemesis occurred or if blood was present in the gastric tube. UGIB was qualified as clinically significant if 2 out of 3 experts independently concluded that at least 1 of 6 complications (transfusion, decreased hemoglobin concentration, hypotension, surgery, multiple organ system failure or death) was attributable to it. The mean time from PICU admission to onset of UGIB or CS-UGIB was obtained by the summation of the number of events multiplied by duration of PICU stay for each event, then divided by the total number of events. The mean incidence density was calculated by dividing the total number of patients with UGIB or CS-UGIB by the cumulative number of patient-days.

Results
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The cohort included 1006 consecutive patients. 103 UGIB (10.2%) were diagnosed, including 16 CS-UGIB (1.6%). The mean time from PICU admission to UGIB and CS-UGIB onset was 4.5 days (95% CI: 1.4--7.6) and 3.9 days (95% CI: 1.4--6.4) respectively. The mean incidence density was 24.6/10 000 patient-days for UGIB and 3.8/10 000 patient-days for CS-UGIB. The estimation of the risk of bleeding by actuarial method indicates that the probability of occurrence of UGIB and CS-UGIB was highest on the second day of PICU stay: 4.7% and 1.2% respectively.

Conclusion
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UGIB and CS-UGIB occur soon after admission to PICU. Prophylaxis to prevent CS-UGIB should be given early to patients at risk of developing this complication.
