Aim To prospectively evaluate the use of bubble continuous positive airway pressure (CPAP) in children with very severe pneumonia and other acute lower respiratory infections, during its trial introduction in a low resource hospital in Papua New Guinea. Methods Prospective observational study of children treated with CPAP who had severe pneumonia and severe respiratory distress with hypoxaemia (SpO2 <90%). CPAP was driven by oxygen concentrators in which the fraction of inspired oxygen could be adjusted, and using low‐resistance tubing and nasal oxygen prongs. Results A total of 64 children were commenced on CPAP: 29 (45.3%) survived and were discharged well, 35 (54.7%) died. Prior to commencing CPAP, the median SpO2 was 78% (IQR 53.3–86.8%), at one hour SpO2 was 92% (IQR 80–97.75%, n = 64), and at 84 hours (3½ days) 98% (IQR 93–98%, n = 29), in survivors at each of these time points. A higher SpO2 at one hour after commencement of CPAP predicted survival (p = 0.013), and human immunodeficiency virus infection was an independent predictors of death (p = 0.017). Technical and clinical problems encountered are described. Conclusion Bubble CPAP improved oxygenation and reduced the severity of respiratory distress in some children with severe pneumonia; however, mortality was high reflecting high severity of illness and comorbidities. CPAP requires a quality system to be safe and effective.

Implementing the World Health Organization (WHO) recommendations on home-based management of pneumonia with chest indrawing is challenging in many settings. In Papua New Guinea, 120 children presenting with the WHO definition of pneumonia were screened for danger signs, comorbidities and hypoxaemia using pulse oximetry; 117 were appropriate for home care. We taught mothers about danger signs and when to return, using structured teaching materials and a video. The children were given a single dose of intramuscular benzylpenicillin, then sent home on oral amoxicillin for 5 days, with follow-up at Days 2 and 6. During the course of treatment, five (4%) of the 117 children were admitted and 15 (13%) were lost to follow-up. There were no deaths. Treating children with pneumonia with chest indrawing but no danger signs is feasible as long as safeguards are in place-excluding high-risk patients, checking for danger signs and hypoxemia and providing education for mothers and follow-up.

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Oral rehydration solution (ORS) is the mainstay of treatment of acute watery diarrhoea, but it is underutilized in many hospitals, resulting in children with moderate degrees of dehydration being unnecessarily hospitalized and receiving intravenous fluids. We aimed to assess the utility of an ORS tolerance test on initial presentation to an emergency department, and determine the volume of ORS a child with diarrhoea and moderate dehydration needed to tolerate to be successfully managed at home. One hundred and twenty-nine children with acute watery diarrhoea and moderate dehydration were given ORS and observed in a Children’s Emergency Department (CED) over a period of 2–4 h. Patients were admitted, kept in the CED for further management or discharged, based on the assessment of oral intake and the clinical judgement of the treating health workers. Seventy-nine (61.2%) patients tolerated ORS well. They drank a median [interquartile range (IQR)] of 24.4 ml (IQR 12.5–28.8) ml/kg, were judged to have passed the ORS test and were discharged to continue oral rehydration treatment at home. At follow-up on days 2 and 5, 63/79 (79.7%) children had improved, were adequately hydrated and the diarrhoea had reduced. Sixteen of the 79 (20.3%) failed oral home treatment, with persisting diarrhoea, vomiting, hypokalaemia and/or weakness. The 63 who succeeded had tolerated a median of 25.8 (IQR 18.4–30.0) ml/kg of ORS in the CED, whilst the 16 who failed oral home treatment had tolerated 11.1 (IQR 9.1–23.0) ml/kg ORS (p < 0.001).

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