LAUSR

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 outcomes. 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(κ) 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. Abstract G257 Table 1 TRY-CPAP outcomes HCW RA IN-O2 CPAP ECPAP Total Paediatrician RA 0 1 0 0 0 IN-O2 1 29 2 1 33 CPAP 0 0 15 1 17 ECPAP 0 0 0 7 7 Total 2 28 18 9 57 HCW=Health Care Worker, RA=Room Air, IN-O2=intranasal oxygen, ECPAP=Early CPAP