Evaluation of ‘TRY’: an algorithm for neonatal continuous positive airways pressure in low-income settings
Open accessAbstract
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 the 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 most 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 baby unit were asked, over a 2-month period, to complete TRY assessments for every newly admitted baby with the following inclusion criteria: clinical evidence of respiratory distress and/or birth weight less than 1.3 kg. A visiting paediatrician, blinded to nurses’ assessments, concurrently assessed each baby, providing both a TRY assessment and a clinical decision regarding the need for CPAP administration. Inter-rater reliability was calculated comparing nursing and paediatrician TRY assessment outcomes. Sensitivity and specificity were estimated comparing nurse TRY assessments against the paediatrician’s clinical decision. Results: Two hundred and eighty-seven infants were admitted during the study period; 145 (51%) of these met the inclusion criteria, and of these 57 (39%) received joint assessments. The inter-rater reliability was high (kappa 0.822). Sensitivity and specificity were 92% and 96%, respectively. Conclusions: District hospital nurses, using the TRY-CPAP algorithm, reliably identified babies that might benefit from bCPAP and thus improved its effective implementation.
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Our findings on shortage of neonatal staff are in line with previous research on bubble CPAP in sub-Saharan Africa where understaffed neonatal units and high turnover of nurses and doctors limited capacity for care.
“Our findings on shortage of neonatal staff are in line with previous research on bubble CPAP in sub-Saharan Africa where understaffed neonatal units and high turnover of nurses and doctors limited capacity for care [9,24,25,33,34].”
From Barriers and enablers of implementing bubble Continuous Positive Airway Pressure (CPAP): Perspectives of health professionals in Malawi (2020) · cites this paper as [24]
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- Authors
- Crehan, C., Colbourn, T., Heys, M., & Molyneux, E.
- Affiliations
- University College London (GB)
- Corresponding author
- Crehan, Caroline
- Venue
- Archives of Disease in Childhood
- Publisher
- BMJ
- Published
- 2018-03-07
- Volume
- 103
- Issue
- 8
- Pages
- 732-738
- ISSN
- 0003-9888 (ISSN-L)
- 1468-2044
- OpenAlex
- W2794412501
- Cited by
- 25
- References
- 20
- Citations by year
- 2025: 3 · 2023: 2 · 2022: 3 · 2021: 3 · 2020: 12 · 2019: 2
- FWCI
- 3.20
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Disease in Childhood (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Rice University
- National Institute for Health and Care Research (CL-2010-18-007)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Neonatal Respiratory Health Research
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
- Keywords
- bubble continuous positive airway pressure, neonatal respiratory distress syndrome, clinical decision algorithm, resource-limited settings, nursing assessment, inter-rater reliability, sensitivity and specificity, low birth weight infants, non-invasive respiratory support
- MeSH terms
- Algorithms, Equipment Design, Female, Hospitalization, Hospitals, District, Hospitals, Teaching, Humans, Infant, Newborn, Malawi, Male, Prospective Studies, Respiratory Distress Syndrome, Newborn, Sensitivity and Specificity, Observer Variation, Patient Selection, Continuous Positive Airway Pressure
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