Introduction: Respiratory failure requiring a temporary artificial airway and mechanical ventilation is a common occurrence in pediatric intensive care units. Ventilator-associated pneumonia (VAP) is a type of hospital-acquired pneumonia that develops after more than 48 hours of mechanical ventilation. It is a common and serious problem in adults with an estimated incidence of 10 to 25 % and an all-cause mortality of 25 to 50 % in certain single center studies. Current National estimates and outcomes of VAP in hospitalized children are unclear. Methods: We performed a retrospective analysis of Nationwide Inpatient Sample (NIS) for the years 2009 and 2010. The NIS is the largest all-payer hospital discharge database in the United States that is a part of the Healthcare Cost and Utilization Project sponsored by the Agency for Healthcare Research and Quality. All pediatric hospitalizations (aged <=21 years) that had mechanical ventilation-MV (ICD-9-CM procedure codes of 96.70, 96.71, and 96.72) were selected for analysis. Ventilator associated pneumonia(VAP [ICD-9-CM Code of 997.31]) was identified for each hospitalization from second diagnostic fields. The primary outcome variables of interest included in-hospital mortality (IHM), length of stay (LOS), and hospitalization charges-HC (inflation-adjusted to year 2010). Multivariable regression analyses were used to examine the association between VAP and outcomes. Multivariable logistic regression was used for IHM while linear regressions were used for LOS and HC. Since LOS and HC were skewed, they were log transformed and used as dependent variables in the regression models. The effects of age, gender, race, type of admission, type of MV, co-morbid burden, and hospital characteristics were adjusted in the regression models. Results: During the study period a total of 317,204 pediatric hospitalizations received mechanical ventilation. The mean age of these patients was 4 years. Males comprised 58.8% of all hospitalizations. A majority of patients (67%) had MV for less than 96 consecutive hours. A total of 30,407 patients died in hospitals (overall IHM rate was 9.6% of all hospitalizations). VAP developed in 0.70% (2220) of all hospitalizations. Mean LOS for those who did not develop VAP was 26.3 days (compared to 48 days for those who developed VAP). Mean HC for those who did not develop VAP was $193,830 (compared to $424,057 for those who developed VAP). IHM rate for those without VAP was 9.6% (30, 183/314,984) and IHM for those with VAP was 10.4% (224/2220). Following adjustment for all confounding factors, those who developed VAP were NOT statistically significantly associated with higher IHM. Following adjustment for all confounding factors, those who developed VAP were associated with significantly higher HC and longer LOS in hospital (p<0.0001). Conclusions: Although the overall incidence of ventilator-associated pneumonia in hospitalized children is low (less than 1%), it is associated with significant hospital resource utilization. In this large cohort, VAP was not associated with increased in-hospital mortality.