Development and validation of a simple algorithm for initiation of CPAP in neonates with respiratory distress in Malawi

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dc.citation.firstpageF332-F336
dc.citation.journalTitleArchives of Disease in Childhood Fetal and Neonatal Edition
dc.citation.volumeNumber100
dc.contributor.authorHundalani, Shilpa G.
dc.contributor.authorRichards-Kortum, Rebecca
dc.contributor.authorOden, Maria
dc.contributor.authorKawaza, Kondwani
dc.contributor.authorGest, Alfred
dc.contributor.authorMolyneux, Elizabeth
dc.date.accessioned2015-06-30T16:22:57Z
dc.date.available2015-06-30T16:22:57Z
dc.date.issued2015
dc.description.abstractBackground:Low-cost bubble continuous positive airway pressure (bCPAP) systems have been shown to improve survival in neonates with respiratory distress, in developing countries including Malawi. District hospitals in Malawi implementing CPAP requested simple and reliable guidelines to enable healthcare workers with basic skills and minimal training to determine when treatment with CPAP is necessary. We developed and validated TRY (T: Tone is good, R: Respiratory Distress and Y=Yes) CPAP, a simple algorithm to identify neonates with respiratory distress who would benefit from CPAP. Objective:To validate the TRY CPAP algorithm for neonates with respiratory distress in a low-resource setting. Methods: We constructed an algorithm using a combination of vital signs, tone and birth weight to determine the need for CPAP in neonates with respiratory distress. Neonates admitted to the neonatal ward of Queen Elizabeth Central Hospital, in Blantyre, Malawi, were assessed in a prospective, cross-sectional study. Nurses and paediatricians-in-training assessed neonates to determine whether they required CPAP using the TRY CPAP algorithm. To establish the accuracy of the TRY CPAP algorithm in evaluating the need for CPAP, their assessment was compared with the decision of a neonatologist blinded to the TRY CPAP algorithm findings. Results: 325 neonates were evaluated over a 2-month period; 13% were deemed to require CPAP by the neonatologist. The inter-rater reliability with the algorithm was 0.90 for nurses and 0.97 for paediatricians-in-training using the neonatologist's assessment as the reference standard. Conclusions:The TRY CPAP algorithm has the potential to be a simple and reliable tool to assist nurses and clinicians in identifying neonates who require treatment with CPAP in low-resource settings.
dc.identifier.citationHundalani, Shilpa G., Richards-Kortum, Rebecca, Oden, Maria, et al.. "Development and validation of a simple algorithm for initiation of CPAP in neonates with respiratory distress in Malawi." <i>Archives of Disease in Childhood Fetal and Neonatal Edition,</i> 100, (2015) BMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health: F332-F336. http://dx.doi.org/10.1136/archdischild-2014-308082.
dc.identifier.doihttp://dx.doi.org/10.1136/archdischild-2014-308082
dc.identifier.urihttps://hdl.handle.net/1911/80838
dc.language.isoeng
dc.publisherBMJ Publishing Group Ltd & Royal College of Paediatrics and Child Health
dc.rightsThis is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
dc.rights.urihttps://creativecommons.org/licenses/by-nc/4.0/
dc.titleDevelopment and validation of a simple algorithm for initiation of CPAP in neonates with respiratory distress in Malawi
dc.typeJournal article
dc.type.dcmiText
dc.type.publicationpublisher version
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