Background: Severe pneumonia remains a common and serious condition worldwide. The mortality from severe pneumonia remains high and is one of the leading causes of morbidity and mortality in under-fives. Objective: To Identify clinical profile and outcome Of Children with Severe Pneumonia. Materials and Methods: This study was a prospective observational cohort study was carried out at 250 Beded General Hospital, Noakhali, Bangladesh from December 2020 to May 2021. Children under 5 years of age admitted with severe pneumonia. One Hundred Fifty included, Due to time limitation collection of this huge amount of sample was not possible within 6 months period. So the total number patients admitted in hospital in this period were included in this study. Results: The mean age was found 9.49±6.83 months with range from 2 months to 36 months and Male to female ratio was 2:1. The duration of hospital stay was >5 days in almost two third (62.7%) of the patients. More than a half (54.7%) of the patients lived in an overcrowded environment at home. The mean age of the mothers was 24.67±4.19 years. Most of the mother had no institutional background, where 22.7% mother cannot read and write at all and 33.3% mother can only read and write. More than two third (66.7%) of the family member of the patients were smoker, 50.7% of the patients got exclusive breast feeding, 9.3% had low birth weight, 6.7% were not completely immunized up to age. Head nodding was more common clinical presentation, which was 92(62.7%) of the study patients, positive blood culture was found in 20(13.3%) and abnormal CXR in 108(72.0%) of the patients. Among 150 study patients, 98(65.3%) needed a change in antibiotics, 94(62.7%) patients needed more than 5 days hospital stay, 30(20.0%) needed mechanical ventilation and 18(12.0%) died. Conclusion: In conclusion to identify the Clinical profile and outcome of children hospitalized with severe pneumonia. Lack of exclusive breast feeding, overcrowding, head nodding on presentation, leukocytosis, positive blood culture, abnormal CXR and exclusive breast feeding were significantly that may reduce their hospital stay. Additional Clinical profile and mortality were anaemia, leukocytosis and positive CRP. So, patients presenting with these factors should preferably be admitted in a paediatric intensive care unit for close monitoring and management that could reduce their mortality.