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Introduction/Purpose Pediatric subarachnoid hemorrhage (SAH) is a rare condition that causes high mortality and significant long-term neurological morbidity. The Global Burden of Disease (GBD) study represents the largest international effort to quantify health outcomes across populations. We hypothesized that lower-income countries demonstrate a disproportionately greater burden of pediatric SAH because they lack timely diagnosis, specialized neurosurgical care, and preventive health resources.Materials and Methods We used the GBD database to extract deaths and prevalence of years lived with disability (YLD) per 100,000 individuals attributable to SAH among patients under 20 years of age for all countries between 1990 and 2023. We also collected data on gross domestic product (GDP) per capita, United Nations geoscheme region, Healthcare Access and Quality Index (HAQI), and neurosurgeons per capita when available.Results 13/20 (65%) countries with the highest burden of pediatric SAH deaths ( figure 1) fell in the middle 50% GDP per capita, and 12/20 (60%) were located in Polynesia, Micronesia, and Melanesia. 12/20 (60%) countries with the highest YLD burden (figure 2) fell in the middle 50% GDP per capita, and 18/20 (75%) were in Polynesia, Micronesia, and Melanesia. 10/20 (50%) countries with the highest death burden reported only 0–1 neurosurgeon per 100,000 population.Conclusion Middle-income countries, particularly in the Pacific Islands, carry a disproportionately high burden of pediatric SAH in deaths and YLDs. Vague presenting symptoms often delay recognition in children, and the scarcity of pediatric neurosurgical and neurointerventional expertise, the lack of equipment and supplies further constrain treatment. Geographic barriers and socioeconomic inequities delay referrals and transfers, which increases risks of complications and long-term cognitive or developmental impairment. Together, these findings highlight the urgent need to strengthen pediatric neurosurgical capacity, expand access to child-appropriate resources, and implement targeted public health interventions that address the unique vulnerabilities of children with SAH.Disclosures K. Desai: None.Abstract P-031 Figure 1Abstract P-031 Figure 2