Background: Bubble continuous positive airway pressure (CPAP) application has become popular in Nigeria against the backdrop of very high incidence of respiratory distress syndrome among preterm neonates in the country. An estimated > 90% of interven-tions in Nigeria is carried out via an improvised technique or use of devices that deliver CPAP gas at room temperatures only. There is however, a high record of neonatal mortality amongst very- and extremely-low birthweight neonates that receive CPAP treatments using these devices. It is suspected that a possible dodgy severe hypothermia could be blamed; hence the need for a preliminary hypothesis.Methods:The aetiology of CPAP iatrogenic hypothermia was studied via free-body modelling to formulate prevailing thermal in-terplay. Thirteen extremely-low birthweight neonates (BW: 600g - 1000g) were recruited to test the hypothesis. Four of these were treated with CPAP-temperature-controlled device, whereas the rest of the 13 were treated with disposable improvised CPAP devices that delivered air at room temperatures. A digital thermometer probe was inserted in the CPAPs’ gas delivery tubes to measure the temperatures of the inspiratory gas just before the infant received this.Results: Only four of the extremely-low birthweight infants were successfully weaned from the CPAP interventions. All four received pre-warmed CPAP gas but all nine unsuccessful infants received CPAP gas at room temperature. All 13 patients maintained physiolog-ical temperatures > 36.5°C, measured superficially via the axilla. Median inspiratory gas temperatures for all the deceased remained below 32°C throughout, whereas those of the successful infants remained above 35.5°C. Conclusion: Acceptable axillary temperatures may be concealing dangerous internal iatrogenic hypothermia, perhaps at the lungs leading to organ failures and death. Internal organ temperatures below 33°C may be insufficient to guarantee neonatal survival. Bubble CPAP gas is therefore recommended to be pre-warmed and delivered at appropriate temperatures akin to incubator environ-ment temperature when treating preterm neonates.