Rationale: Limited data exist about the international burden of severe sepsis in critically ill children. Objectives: To characterize the global prevalence, therapies, and outcomes of severe sepsis in pediatric intensive care units to better inform interventional trials. Methods: Point prevalence study conducted on 5 days throughout 2013-2014 in 128 sites from 26 countries. Patients <18 years with severe sepsis defined by consensus criteria were included. Outcomes were severe sepsis point prevalence, therapies used, new or progressive multi-organ dysfunction, ventilator- and vasoactive-free days at day 28, functional status, and mortality. Measurements and Main Results: Of 6925 patients screened, 569 had severe sepsis (prevalence 8.2%, 95% CI 7.6, 8.9%). Median age was 3.0 (IQR 0.7-11.0) years. The most frequent sites of infection were respiratory (40%) and bloodstream (19%). Common therapies included mechanical ventilation (74% of patients), vasoactive infusions (55%), and corticosteroids (45%). Hospital mortality was 25% and did not differ by age or between developed and resource-limited countries. Median ventilator-free days were 16 (IQR 0-25) and vasoactive-free days were 23 (IQR 12-28). Sixty-seven percent had multi-organ dysfunction at sepsis recognition, with 30% subsequently developing new or progressive multi-organ dysfunction. Amongst survivors, 17% developed at least moderate disability. Sample sizes to detect a 5-10% absolute risk reduction in outcomes within interventional trials are estimated between 165-1437 patients per group. Conclusions: Pediatric severe sepsis remains a burdensome public health problem, with prevalence, morbidity, and mortality rates similar to reports from critically ill adult populations. International clinical trials targeting children with severe sepsis are warranted.