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Evaluation of 'Try' an algorithm for neonatal cpap in low-income settings

By:

Crehan, C

Publication details: 2018Uniform titles:

Archives of Disease in Childhood

Online resources:

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Summary: Background Non-invasive respiratory support using bubble continuous positive airway pressure (bCPAP) is useful in treating babies with respiratory distress syndrome. Despite its proven clinical and cost effectiveness, implementation is hampered by inappropriate administration of bCPAP in low-resource settings. A clinical algorithm-'TRY' (based on Tone: good, Respiratory distress: Yes: heart rate above 100 beats/min) has been developed to correctly identify which newborns would benefit from bCPAP in a teaching hospital in Malawi. Objective To evaluate the reliability, sensitivity and specificity of TRY when employed by nurses in a Malawian district hospital. Methods Nursing staff in a Malawian district hospital neonatal unit were asked, over a 2 month period, to complete TRY assessments for every newly admitted baby with the inclusion criteria: clinical evidence of respiratory distress and/or birth weight less than 1.3 kg. A visiting paediatrician, blinded to the nurses' assessments, concurrently assessed each baby providing both a TRY assessment and a clinical decision regarding the need for CPAP administration. Interrater reliability was calculated comparing nursing and paediatrician TRY assessment out-comes. Sensitivity and specificity were estimated comparing nurse TRY assessments against the paediatrician's clinical decision. Results 287 infants were admitted during the study period; 145 (51%) met the inclusion criteria and of these, 57 (39%) received joint assessments. The inter-rater reliability was high, (kappa(K) 0.822). Sensitivity and specificity were 92% and 96% respectively. Conclusions District hospital nurses, using the TRY-CPAP algorithm, reliably identify babies that might benefit from bCPAP and thus improve its effective implementation. [Conference abstract]

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NMUH Staff Publications

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Background Non-invasive respiratory support using bubble continuous positive airway pressure (bCPAP) is useful in treating babies with respiratory distress syndrome. Despite its proven clinical and cost effectiveness, implementation is hampered by inappropriate administration of bCPAP in low-resource settings. A clinical algorithm-'TRY' (based on Tone: good, Respiratory distress: Yes: heart rate above 100 beats/min) has been developed to correctly identify which newborns would benefit from bCPAP in a teaching hospital in Malawi. Objective To evaluate the reliability, sensitivity and specificity of TRY when employed by nurses in a Malawian district hospital. Methods Nursing staff in a Malawian district hospital neonatal unit were asked, over a 2 month period, to complete TRY assessments for every newly admitted baby with the inclusion criteria: clinical evidence of respiratory distress and/or birth weight less than 1.3 kg. A visiting paediatrician, blinded to the nurses' assessments, concurrently assessed each baby providing both a TRY assessment and a clinical decision regarding the need for CPAP administration. Interrater reliability was calculated comparing nursing and paediatrician TRY assessment out-comes. Sensitivity and specificity were estimated comparing nurse TRY assessments against the paediatrician's clinical decision. Results 287 infants were admitted during the study period; 145 (51%) met the inclusion criteria and of these, 57 (39%) received joint assessments. The inter-rater reliability was high, (kappa(K) 0.822). Sensitivity and specificity were 92% and 96% respectively. Conclusions District hospital nurses, using the TRY-CPAP algorithm, reliably identify babies that might benefit from bCPAP and thus improve its effective implementation.&nbsp;[Conference abstract]

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