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Objectives: To evaluate the effect of 25% albumin in addition to standard treatment (ST) in children with fluid refractory severe dengue on morbidity and mortality compared with ST alone., Methods: This was a comparative study that enrolled children aged 2 months to 18 years with severe dengue who presented to emergency between 2021-2023. Patients who were in circulatory shock after 40 mL per kg of crystalloid/colloid bolus within 1-2 hours of admission were equally categorized into two groups. ST-plus albumin group enrolled patients prospectively and received an albumin infusion (0.5-1 g/kg) in addition to ST as per WHO guidelines. ST-only group enrolled patients retrospectively who had received only ST. Demographic data, clinical course, laboratory parameters and outcomes were compared., Results: Baseline characteristics were comparable between the two groups. Survival was significantly higher in the ST-plus albumin group (97.1%) than in the ST-only group (77.1%); P = 0.043. The need for inotropic support was significantly lower in ST-plus albumin group (60%) than ST-only group (94.3%); P < 0.001. The incidence of bleeding (P = 0.008), AKI (P = 0.065), need for diuretics (P = 0.029) and renal replacement therapy (P = 0.028) were significantly lower in children in the ST-plus albumin group than ST-only group., Conclusion: The addition of 25% albumin to fluid refractory severe dengue early in the disease course led to better survival, less fluid accumulation and bleeding, and lesser incidence of complications.