ObjectiveTo understand the risk factors for poor prognosis of severe adenovirus pneumonia (SAP) in children, and provide guidance for clinical diagnosis and prognosis.MethodsClinical data of 91 hospitalized children who diagnosed with SAP in Chongqing Children’s Hospital of Chongqing Medical University between January 2012 and  January 2014 were analyzed retrospectively.ResultsOf 91 SAP children, 23（25.27%）had poor prognosis. Univariate analysis showed that risk factors for poor prognosis of SAP were age of onset, congenital heart disease and other serious underlying diseases, mechanical ventilation therapy, acute respiratory distress syndrome (ARDS), atelectasis and other serious radiological changes, and emergence of two and more  extrapulmonary complications (all P<0.05）. Multivariate regression analysis showed that congenital heart disease and other serious underlying diseases, and emergence of two and more  extrapulmonary complications were independent risk factors for poor prognosis of SAP  (all P<0.05）.ConclusionCongenital heart disease and other serious underlying diseases, emergence of two and more extrapulmonary  complications are independent risk factors for poor prognosis of SAP, active intervention should be conducted during the process of clinical diagnosis and treatment, so as to improve the prognosis.