Background: Inter-hospital transfer of critically ill children carries substantial risk, particularly when pre-transfer stabilization is inadequate. Structured call conference–based assessments between peripheral hospitals and tertiary paediatric intensive care units (PICUs) may improve communication and optimize stabilization prior to transport. This audit evaluated the clinicalstatus of paediatric patients before transfer and upon admission to a PICU following structured call conference assessments. Method: A prospective audit was conducted over three months, including all paediatric patients transferred from peripheral hospitals to PICU at National hospital Galle. Twenty-ninetransfers were analyzed. A structured call conference form was completed prior to transfer,documenting initial clinical parameters, which were discussed with the receiving ICU consultant. Stabilization advice for transport and interim ward management was provided.Patient status was reassessed on PICU admission. Results: Of 29 critically ill children, 4 (13.8%) developed cardiovascular instability duringtransport despite being stable at departure. Respiratory status remained stable in most cases with appropriate support; however, one patient (3.4%) experienced endotracheal tube dislodgement requiring repositioning. Neurological deterioration was observed in 3 patients (10.3%) who had dilated, non-reactive pupils on admission despite on departure reactive pupils. Deterioration was associated with equipment malfunction, inadequate monitoring, insufficient drug preparation, junior escorting staff lacking airway skills, and communication gaps. Conclusion: Structured call conference assessments, strict adherence to stabilization advice, competent transport personnel, and standardized pre-transfer checklists are essential to improve physiological stability and ensure safer paediatric inter-hospital transfers.