👶 Neonatal Hypoxic-Ischemic Encephalopathy Staging (Sarnat)
UseUse in term/near-term newborns with suspected perinatal asphyxia to grade encephalopathy severity and decide …
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SourceSarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. Arch Neurol 1976.
Runs locally in your browser (no PHI uploaded). For licensed clinicians — not a substitute for clinical judgement.
Stored on this device for revisit reminders
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
Scene next step
📋Seizure / consciousnessOpen scene pack →Related scores
Matching pathway
🧭status_epiOpen pathway →Score + version; reference only — not a substitute for care · no HIS write
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Methodology · worked example, guidelines & full notes
Clinical takeaway
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.
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
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Level of consciousness | Lethargic / obtunded (2) |
|---|---|
| Muscle tone | Decreased (2) |
| Primitive reflexes (suck / Moro) | Weak (2) |
| Autonomic function | Parasympathetic predominant (miosis / bradycardia) (2) |
| Seizures | None |
| 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 | Not met |
→Sarnat stageStage 2 (moderate)
- Stage：Stage 2 moderate: lethargic/obtunded, decreased tone, seizures common, parasympathetic (miosis/bradycardia), roughly 2–14 days
- Hypothermia eligibility：Moderate-to-severe encephalopathy, but asphyxia evidence / GA / time window not fully met — verify cord gas / Apgar / resuscitation history and age; decide within the 6 h window as quickly as possible (≥ 2 moderate-to-severe features or seizures warrants assessment)
- Management direction：Supportive care: maintain normothermia (avoid hyperthermia), glucose, electrolytes, perfusion and oxygenation; control seizures; multimodal prognostication (evolving neuro exam + aEEG/EEG + MRI)
| Level of consciousness | Hyperalert / irritable (1) |
|---|---|
| Muscle tone | Normal or mildly increased (1) |
| Primitive reflexes (suck / Moro) | Active / normal (1) |
| Autonomic function | Sympathetic predominant (mydriasis / tachycardia) (1) |
| Seizures | None |
| 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 | Not met |
→Sarnat stageStage 1 (mild)
- Stage：Stage 1 mild: hyperalert, normal or mildly increased tone, active reflexes, sympathetic overactivity, no seizures, usually < 24 h
- Hypothermia eligibility：Stage 1 (mild) generally does not warrant hypothermia; monitor closely and reassess if it progresses to moderate-to-severe and criteria are met
- Management direction：Supportive care: maintain normothermia (avoid hyperthermia), glucose, electrolytes, perfusion and oxygenation; control seizures; multimodal prognostication (evolving neuro exam + aEEG/EEG + MRI)
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Neonatal Hypoxic-Ischemic Encephalopathy Staging (Sarnat)?
- For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
- Does Neonatal Hypoxic-Ischemic Encephalopathy Staging (Sarnat) upload patient data? Where is it calculated?
- Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
- How is Neonatal Hypoxic-Ischemic Encephalopathy Staging (Sarnat) calculated in practice? Can you show a worked example?
- Inputs: Level of consciousness Lethargic / obtunded (2), Muscle tone Decreased (2), Primitive reflexes (suck / Moro) Weak (2), Autonomic function Parasympathetic predominant (miosis / bradycardia) (2), Seizures None, 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 Not met → Result: Sarnat stage Stage 2 (moderate)（Stage: Stage 2 moderate: lethargic/obtunded, decreased tone, seizures common, parasympathetic (miosis/bradycardia), roughly 2–14 days, Hypothermia eligibility: Moderate-to-severe encephalopathy, but asphyxia evidence / GA / time window not fully met — verify cord gas / Apgar / resuscitation history and age; decide within the 6 h window as quickly as possible (≥ 2 moderate-to-severe features or seizures warrants assessment), Management direction: Supportive care: maintain normothermia (avoid hyperthermia), glucose, electrolytes, perfusion and oxygenation; control seizures; multimodal prognostication (evolving neuro exam + aEEG/EEG + MRI)） Inputs: Level of consciousness Hyperalert / irritable (1), Muscle tone Normal or mildly increased (1), Primitive reflexes (suck / Moro) Active / normal (1), Autonomic function Sympathetic predominant (mydriasis / tachycardia) (1), Seizures None, 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 Not met → Result: Sarnat stage Stage 1 (mild)（Stage: Stage 1 mild: hyperalert, normal or mildly increased tone, active reflexes, sympathetic overactivity, no seizures, usually < 24 h, Hypothermia eligibility: Stage 1 (mild) generally does not warrant hypothermia; monitor closely and reassess if it progresses to moderate-to-severe and criteria are met, Management direction: Supportive care: maintain normothermia (avoid hyperthermia), glucose, electrolytes, perfusion and oxygenation; control seizures; multimodal prognostication (evolving neuro exam + aEEG/EEG + MRI)）