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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 (SpO 2  <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 SpO 2  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 SpO 2  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.

Continuous positive airway pressure in children with severe pneumonia and hypoxaemia in Papua New Guinea: an evaluation of implementation