This study by S.K. Satpathy, N. Mohanty, P. Nanda, and G. Samal from the Department of Pediatrics at M.K.C.G. Medical College and Hospital in Berhampur, India, examines the clinical patterns and mortality of severe falciparum malaria in 242 pediatric patients with a median age of 6.5 years. The most common complications were unarousable coma (40.5%), severe anemia (26.03%), repeated seizures (46.2%), and hepatopathy (32.2%). Under-five children had a higher risk of developing cerebral malaria, severe anemia, and seizures, while older children had a higher risk of acute renal failure and malarial hepatopathy. The overall mortality rate was 9.9%, with cerebral malaria being the leading cause (6.6%). Multi-system involvement was observed in 58.4% of deaths. The study highlights the changing trends in pediatric falciparum malaria, particularly the higher incidence of hepatopathy in older children, which may be due to changing parasitic virulence factors or other cofactors.This study by S.K. Satpathy, N. Mohanty, P. Nanda, and G. Samal from the Department of Pediatrics at M.K.C.G. Medical College and Hospital in Berhampur, India, examines the clinical patterns and mortality of severe falciparum malaria in 242 pediatric patients with a median age of 6.5 years. The most common complications were unarousable coma (40.5%), severe anemia (26.03%), repeated seizures (46.2%), and hepatopathy (32.2%). Under-five children had a higher risk of developing cerebral malaria, severe anemia, and seizures, while older children had a higher risk of acute renal failure and malarial hepatopathy. The overall mortality rate was 9.9%, with cerebral malaria being the leading cause (6.6%). Multi-system involvement was observed in 58.4% of deaths. The study highlights the changing trends in pediatric falciparum malaria, particularly the higher incidence of hepatopathy in older children, which may be due to changing parasitic virulence factors or other cofactors.