Objective Assessment and Communication of the Physiologic Status of the Sick Infant

Andrew J. Macnab, MD

The practice of midwifery involves the initial and ongoing assessment of newborn infants in terms of their maturity, transition to extrauterine life, completeness of resuscitation and ongoing health status. The universally familiar Apgar 1 score is an essential tool for initial neonatal assessment for midwives as for other medical professionals. The score was developed by Virginia Apgar as an objective measure of the physiologic status of the infant after birth, and to quantify the progress through, and adequacy of, resuscitation and adaptation to extra-uterine life. While elements of the Apgar score are relevant for assessing and describing the status of the infant after 10 minutes of age, the score as a whole is not used routinely beyond this time. The Pediatric Assessment Triangle (PAT) is a newly 2,3 developed tool for ongoing, objective assessment of an infant's (or child's) physical appearance. The PAT can be used to describe the presence of abnormal physiology, define whether an infant is in distress or actually experiencing system failure, and assess the infant's response to intervention by observing the resolution or progression of the clinical problem. The PAT has the potential to be a valuable tool for midwives, both for ongoing assessment, and as a means of describing the status of an infant to other health care professionals using objective terminology. The use of objective criteria and precise terminology can strengthen the impact and relevance of communication and contribute to logical decision-making about immediate care and long-term disposition. A consistent framework is also valuable when providing follow-up, particularly where a treatment or intervention has been suggested and it is important to communicate whether the infant has responded. The purpose of this paper is to describe the Pediatric Assessment Triangle, explain how it is applied and to suggest the use of this tool by midwives in practice.

This article has been peer-reviewed.


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