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Systematic review
Bubble CPAP may be safe and efficacious for neonates in low and middle income countries, but more evidence is needed
  1. Ryan M McAdams
  1. Division of Neonatology, Department of Pediatrics, University of Washington, Seattle, Washington, USA
  1. Correspondence to : Dr Ryan M McAdams, Division of Neonatology, Department of Pediatrics, University of Washington, 1959 NE Pacific Street, Box 356320, Seattle, WA 98195, USA; mcadams{at}

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Neonatal respiratory distress associated with prematurity, surfactant deficiency, sepsis and birth asphyxia, significantly contributes to morbidity and mortality globally. In high income countries, nasal continuous positive airway pressure (CPAP) initiated in the delivery room, compared with intubation and mechanical ventilation, reduces death or bronchopulmonary dysplasia in preterm babies born <32 weeks’ gestation.1 In low and middle income countries (LMIC) with limited resources, bubble CPAP may provide affordable, safe and effective respiratory support in hospital settings.

The systematic review and meta-analysis examines the evidence for the efficacy and safety of CPAP (particularly bubble CPAP) as a primary respiratory support in neonates <28 days old with respiratory distress in LMIC hospital settings.


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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.