👶 Neonatal Hypoxic-Ischemic Encephalopathy Staging (Sarnat)
Sarnat staging grades neonatal hypoxic-ischemic encephalopathy (HIE) as mild, moderate or severe from the overall pattern of consciousness, tone, reflexes, autonomic function and seizures.
Neonatal Hypoxic-Ischemic Encephalopathy Staging (Sarnat)
Level of consciousness
Muscle tone
Primitive reflexes (suck / Moro)
Autonomic function
Seizures
Evidence of perinatal asphyxia (cord pH ≤ 7.0 or BE ≤ −12 / 10-min Apgar ≤ 5 / required resuscitation) AND GA ≥ 35 wk AND < 6 h of age
When to use
Use in term/near-term newborns with suspected perinatal asphyxia to grade encephalopathy severity and decide on therapeutic hypothermia.
How it works
A stage-3 pattern in any domain = severe (stage 3); any moderate feature or seizures = moderate (stage 2); otherwise mild (stage 1). Hypothermia eligibility = stage 2–3 + asphyxia evidence + GA ≥ 35 wk + < 6 h of age.
Key points
- Moderate-to-severe HIE (stage 2–3) within 6 hours of birth, with evidence of perinatal asphyxia, is the trigger for therapeutic hypothermia at 33–34 °C for 72 hours.
- Staging is based on the evolving overall pattern, not a single sign; seizures or any moderate-domain feature already place the infant at stage 2.
- Supportive care (normothermia, glucose, perfusion, seizure control) and multimodal prognostication (neuro exam, aEEG/EEG, MRI) accompany staging regardless of cooling.
References
- Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. Arch Neurol 1976.
- Jacobs SE, et al. Cooling for newborns with HIE. Cochrane Database Syst Rev 2013.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.