Effect of bubble-continuous positive airway pressure (CPAP) on outcome of severe childhood pneumonia and neonatal respiratory distress in children in Papua New Guinea and Solomon Islands

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Despite the availability of effective antibiotics for the common causes of bacterial pneumonia, and despite the availability of oxygen, in Papua New Guinea the death rate for pneumonia sick enough to require hospital admission is 5%, and the death rate for severe pneumonia is 11%. This is similar in many resource-limited developing countries. Supportive care, including oxygen, fluids and nutrition are vital to reducing pneumonia death rates. Oxygen supplies are often unreliable in developing countries, and we have shown that in PNG oxygen has been most reliably and most efficiently delivered using concentrators. However in PNG and Solomon Islands oxygen is the highest level of respiratory support that can be provided to seriously ill children, there is no intensive care services. Continuous positive airway pressure (CPAP) is often used for severe respiratory distress in developed countries, but CPAP has not been available in developing countries because of cost and complexity. We are trialling a form of CPAP that does not require external sources of oxygen, or external source of medical air, but delivers bubble-CPAP through a modified high-flow oxygen concentrator that can give an air-oxygen mixture. This technology is being trialled in 9 provincial hospitals in PNG and the Solomon Islands, where pneumonia is the number 1 cause of child deaths. The aim of the study is to evaluate whether bubble-CPAP will reduce death rates from pmeumonia, and reduce death rates for newborns with respiratory distress

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