Continuous Positive Airway Pressure (CPAP) use in Rwanda compared to the TRY-CPAP algorithm - a retrospective descriptive study

INTRODUCTION: The TRY-CPAP algorithm was designed in Malawi to guide medical and non-medical healthcare professionals (HCPs) in decision making regarding which neonates should be managed with CPAP [1]. TRY-CPAP stands for “T: Tone is good, R: Respiratory Distress (sats <90% in 1l O₂) and Y=Yes (HR>100)”. The TRY-CPAP algorithm supports not giving CPAP to neonates less than 1kg or those with poor tone (reflecting hypoxic-ischemic encephalopathy (HIE)), because of poor anticipated outcomes.
AIM: The aim of this descriptive research project was to evaluate baseline data on the outcomes of neonates within each of the five TRY CPAP groups.
METHODS: A retrospective, descriptive study was conducted at neonatology units at a referral hospital (CHUK) and a district hospital (Muhima, MDH). A retrospective file review was undertaken of included neonates using a non-printed questionnaire. 178 neonates were enrolled.
RESULTS: Oxygen was used in 74% of neonates and CPAP used in 43% of neonates. When CPAP was used, the mean duration was 3.8 days. 71% of neonates were found to have been allocated to CPAP in a manner concordant with the TRY-CPAP algorithm.
DISCUSSION: The TRY-CPAP algorithm could be appropriate for rationing CPAP in neonatology units in Rwanda. However, further work is required to identify appropriate thresholds for each treatment group prior to implementation in the Rwandan context.

Keywords
Continuous Positive Airway Pressure; Infant, newborn; infant mortality; Intensive Care Units, Neonatal; Africa; Rwanda