Characteristics of included studies
| Author, Year | Country and setting | Study design | Sample size and population | Intervention and equipment | Comparison | Outcomes of interest |
| Randomised control trials | ||||||
| Cam, 20029 | Vietnam Referral hospital Intensive care unit | Randomised control trial | N=37 Age 0–15 years, dengue shock syndrome with respiratory failure despite nasal canula oxygen | CPAP (n=18) Via Beneveniste valve | Oxygen mask (n=19) | Mortality Adverse events Success of treatment at 30 min* and 24 hours |
| Chisti, 201510 | Bangladesh Center for Diarrhoeal Disease Research Intensive care unit | Randomised control trial | N=225 Age 0–5 years, severe pneumonia and hypoxemia | Locally constructed bCPAP (n=79) | Low flow oxygen (n=67) High flow oxygen (n=79) | Mortality treatment failure* (clinical failure, mechanical ventilation or death) Duration of hospital stay Duration of symptoms |
| Lal, 201811 | India Referral hospital | Randomised control trial | N=72 Age 1–12 months, acute bronchiolitis with wheezing | bCPAP via Gregory circuit (n=36) | Standard of care with oxygen mask (n=36) | Mortality Adverse events Need for mechanical ventilation Change in vital signs* and MPSNZ-SS+ and SA score+ |
| McCollum, 201912 | Malawi District Hospital General ward | Randomised control trial | N=644 Age 1–59 months, severe pneumonia and one or more high risk conditions (HIV infection or exposure, Hypoxemia, severe malnutrition) | bCPAP via Fisher and Paykel healthcare CPAP system (n=321) | Low-flow oxygen (n=323) | Mortality* Adverse events Duration of respiratory support |
| Morales, 200415 | Mexico National Institute of Respiratory Disease Intensive care unit | Prospective comparative study‡ | N=26 Age 0–14 years, acute respiratory failure, Glasgow Coma Score >8 | NIV via quantum ventilator (n=14) | Orotracheal intubation (n=12) | Mortality Adverse events Treatment success* (vital sign stabilisation after 2 hours) Vital sign changes Duration of hospital stay |
| Wilson, 201313 | Ghana Four district hospitals General wards | Crossover randomised control trial | N=69 Age 3 months to 5 years, tachypnoea and retractions or nasal flaring | Hudson RCI CPAP nasal cannula and DeVilviss IntelliPAP CPAP machine | Immediate CPAP use (n=31) delayed CPAP use (n=38) | Mortality Change in vital signs* |
| Wilson, 201714 | Ghana District hospital and Municipal hospital General wards | Crossover cluster Randomised control trial | N=2200 Age 1 month-5 years, tachypnoea and retractions or nasal flaring | Hudson RCI CPAP nasal cannula and DeVilviss IntelliPAP CPAP machine (n=1025) | Oxygen via non-rebreather face mask (n=1175) | Mortality* Adverse events Duration of CPAP |
| Non-comparative studies | ||||||
| Balfour-Lynn, 201416 | Ghana District hospital General ward | Observational implementation study20 | N=106 Age 0–5 years, respiratory distress based on respiratory rate, SpO2, intercostal retractions and grunting | NIV via Nippy Junior paediatric pressure controlled portable ventilator | N/A | Mortality* Adverse events |
| Bjorkland, 201917 | Uganda Referral hospital Acute care unit | Prospective, non-blinded, non-randomised interventional study | N=83 Age 30 days - 5 years, moderate or severe respiratory distress based on a calculated respiratory score (Tal score >3) or hypoxia despite low-flow oxygen | SEAL-bCPAP with nasal prong adaptation from ear plug material | N/A | Mortality* Adverse events* Change in respiratory rate, oxygen saturation and Tal score† |
| Bonora, 201118 | Argentina Referral hospital Intensive care unit | Retrospective observational study | N=154 Age 1–18 years, patients needing NIV for >30 min to attempt to avoid intubation | Neumovent graph, neumovent graph net or harmony devices for NIV | N/A | Mortality Need for intubation* Duration of NIV Duration of hospital stay |
| Brown, 201327 | Malawi Referral hospital | Case report | N=1 Age 6 months, respiratory distress | Low cost bCPAP device developed by authors | N/A | Mortality Adverse events Vital sign changes after 1 hour Length of hospital stay |
| Figuera, 201719 | Argentina Provincial hospital Intermediate care unit | Retrospective descriptive study | N=120 Age 1–24 months, weight <12 kg, Tal score >5 | Hudson RCI-CPAP | N/A | Mortality Adverse events Success of CPAP (15% decrease in RR) Changes in vital signs and Tal score† Duration of NIV Duration of ICU stay |
| Ghiggi, 200020 | Argentina Referral hospital Intensive care unit | Prospective observational study | N=42 Age 1 month- 5 years, Acute respiratory failure from pulmonary cause with indication for mechanical ventilation | Nasopharyngeal CPAP via Sechrist IV100 B respirators | N/A | Mortality Adverse events Need for mechanical ventilation* Change in vital signs Duration of NIV |
| Kinikar, 201121 | India Referral hospital Intensive care unit | Case-control study | N=36 Age 0–12 years, influenza like illness, moderate to severe respiratory distress or respiratory failure | Locally constructed nasal bubble CPAP | N/A | Mortality Adverse events Changes in vital signs in first 6 hours* |
| Lum, 201122 | Malaysia Referral hospital Intensive care unit | Prospective observational study | N=129 Age 0–16 years, patients deemed likely to require intubation based on vital signs and work of breathing | NIV via Mapleson F breathing system | N/A | Mortality Adverse events Length of NIV Length of PICU stay Treatment success* (intubation avoided) Vital Sign changes |
| Machen, 201523 | Malawi Referral hospital Acute care unit | Prospective observational study | N=79 Weight<10 kg, respiratory distress, bCPAP deemed appropriate by physician | bCPAP | N/A | Mortality* Duration of bCPAP Duration of hospital stay Change in RISC score† |
| McCollum, 201128 | Malawi Referral hospital | Case report | N=1 3 month old, respiratory distress | Hudson RCI -bCPAP | N/A | Mortality Adverse events Duration of bCPAP Change in vital signs |
| Myers, 201924 | Malawi Referral hospital Critical care zone, emergency zone | Prospective observational study | N=117 Age 0–59 months, severe respiratory distress | Diamedica “Baby CPAP” | N/A | Mortality* Adverse events |
| Pulsan, 201925 | Papua New Guinea Referral hospital Intensive care unit, Special care nursery | Prospective observational study | N=64 Children with severe acute lower respiratory infection, with hypoxaemia or severe respiratory distress despite standard oxygen therapy | Diamedica-modified Airsep intensity bCPAP | N/A | Mortality Change in respiratory distress score*† |
| Walk, 201626 | Malawi Referral hospital High dependency unit, emergency ward | Prospective observational study | N=77 Age 1 week to 14 years, progressive acute respiratory failure despite oxygen and antimicrobial therapy | Locally constructed CPAP | N/A | Mortality* Adverse events Treatment failure (death or intubation) Duration of CPAP Changes in vital signs |
*Primary outcome.
†Scoring tool to evaluate illness severity
‡Non-randomised comparative study.
bCPAP, bubble continuous positive airway pressure; CPAP, continuous positive airway pressure; HIV, immunodeficiency virus; ICU, intensive care unit; MPSNZ-SS, Modified paediatric society of New Zealand severity score; NIV, non-invasive ventilation; PICU, paediatric intensive care unit; RICS score, respiratory index of severity in children.