Objective: Identify predisposing factors to develop severe pneumonia in hospitalized children diagnosed with community-acquired pneumonia hospitalized in Cartagena´s Napoleón Franco Pareja children´s Hospital.Methods: Analytical observational cross-sectional study performed in patients under 18 years. Data from surveys and records were analyzed. Univariate and bivariate analysis was performed. The variables are grouped according to the presence or absence of complications and analyzed by ji-square test. We were calculating OR of each of the dummy variables to evaluate their association with complications was performed. A P < 0.05 was considered statistically significant for all analyzes.Results: 301 patients with severe pneumonia were included. Risk factors related to severity: age less than 3 months (OR: 4.86; CI 95%: 1,5 - 14.3; p = 0.004); exclusive breastfeeding for less than 6 months (CI:95% 7,7- 1,4; p = 0.0019); heart disease (OR: 5.37; CI 95%: 1,28- 19,88, p = 0.010); prematurity (OR: 1.62, CI 95%: 0.93- 6.69, p = 0.034); Incomplete vaccination (OR: 2.32; CI: 95% 1.07 - 5.10; p = 0.015).Conclusions: It was found increased severity risk, statistical significantly, in patients less than 6 months breastfeeding, prematurity, heart disease, incomplete vaccination scheme, and positive blood culture with Sp. pneumoni
