McCollum ED, Mvalo T, Eckerle M, et al. - In order to define outcomes of bubble continuous positive airway pressure (bCPAP) in high-risk African children with severe pneumonia, researchers undertook this open-label, randomised, controlled trial in the general paediatric ward of Salima District Hospital, Malawi. Given most child pneumonia hospitalisations in Africa occur in non-tertiary district hospitals without daily physician oversight, this inquiry was performed to determine if severe pneumonia mortality in such settings could be improved by using bCPAP. Using randomization, the eligible children were allocated 1:1 to low-flow nasal cannula oxygen or nasal bCPAP. Among high-risk Malawian children with severe pneumonia, no reduction in hospital mortality was brought about by bCPAP treatment in a paediatric ward without daily physician supervision, compared with oxygen. Not known previously, a possibility of the presence of risk in relation to bCPAP use within certain patient populations and non-intensive care settings was suggested in this study. There is a need to further assess bCPAP in low-income and middle-income countries prior to wider implementation for child pneumonia care.