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Nasal CPAP for neonatal respiratory support in low and middle-income countries
  1. Tom Lissauer1,
  2. Trevor Duke2,
  3. Kathy Mellor3,
  4. Liz Molyneux4
  1. 1Centre for International Child Health, Imperial College, London W2 1PG, UK
  2. 2University Department of Paediatrics, Royal Children's Hospital, Parkville, Victoria, Australia
  3. 3BirthLink, London, UK
  4. 4Department of Paediatrics, College of Medicine, Blantyre, Malawi
  1. Correspondence to Tom Lissauer, Centre for International Child Health, Imperial College, London, UK; t.lissauer{at}

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The use of nasal continuous positive airway pressure (NCPAP) for neonatal respiratory support is increasing in low and middle-income countries (LMICs). WHO recommends its use in preterm infants with respiratory distress syndrome.1 Although the development of low-cost delivery systems has increased the availability of CPAP, it is not a simple intervention. Our experience of introducing NCPAP into LMICs including Rwanda, Malawi, Armenia, Papua New Guinea and other countries indicates that many issues need addressing for its successful introduction and use.

The role of CPAP in helping reduce neonatal mortality

Globally, neonatal deaths now account for 45% of under-5 mortality.2 The three main causes of neonatal mortality—prematurity, sepsis and intrapartum-related conditions—are all associated with respiratory distress, and so effective respiratory support could greatly improve neonatal outcomes. CPAP prevents alveolar collapse at end-expiration, helps to stabilise the chest wall and reduce the work of breathing. Thus, CPAP is widely used in high-income countries (HICs) to support preterm infants with immature lungs, moderate respiratory distress, sepsis or apnoea; and, increasingly, in extremely low birthweight infants from the time of birth to reduce the need for intubation and artificial ventilation.

Issues to consider before introducing CPAP

These include the type of system to choose, the selection of the patients most likely to benefit, the nursing care required and its implication for other infants, the training needed for the prevention and detection of complications, equipment maintenance and replacement, and the local leadership and motivation essential for success.

Choice of CPAP system

Several issues need to be considered when selecting from the range of systems now available: these include the choice of device, the gas source and the nasal interface. The choice of device should be determined in conjunction with local strategic plans to avoid multiple different systems within a geographical area. Although it may be difficult, we are aware of regions or countries that have a unified programme while others have up …

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  • Contributors This editorial was conceived and written by TL and modified by contributing authors, TD, KM and LM. All authors approved the final article.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.