Pneumococcal meningitis causes high morbidity or mortality in childhood despite the progress in medicine. Children with pneumococcal meningitis were identified and retrospectively reviewed. Forty-nine children were eligible, with mortality in 24.5% of all and neurological sequelae in 40.5% of survivors. In the analysis of clinical profiles, ventilator support (p=0.001), septic shock (p < 0.001), multiple organ failure (p < 0.001) and lower cerebrospinal fluid (CSF) leukocyte count (p=0.001) were more frequently found in non-survivors. Besides, CSF protein (p=0.006) was higher in survivors with neurological sequelae. Initial dexamethasone usage and disease severity did not affect the occurrence of neurological sequelae. Multivariate logistic regression analysis revealed that CSF leukocyte count ≤200 mm−3 (p=0.013) and protein level ≥330 g l−1 (p=0.022) were significantly risk factors associated with poor outcomes, and physicians should be cautious if such conditions occur.