The Sarnat Grading Scale of HIE (Hypoxic-Ischemic Encephalopathy) is a scoring system used to grade the severity of an HIE injury.
To the right is Alissa, the founder’s daughter, several days after birth. She suffered severe HIE and is being tapped with a respritary cup to help to clear secretions from her lungs. Also note the NG or Nasal Gastric Tube used for feeding. Her low tone did not allow her body to control saliva from entering and accumlating in her lungs. Also notice the cap on her head, she was kept warm from her birth. Modern treament is to place HIE infants into a cold state to slow down the metabulism and help prevent what is know as the “Cascade of Neurologic Injury” that occurs in the first 48-72 hours after birth.
Dr. Sarnat
The clinical characteristics of HIE (Hypoxic-Ischemic Encephalopathy) can be described as mild, moderate, or severe. The most common grading or staging system is by the Sarnat scale developed by Sarnat and Sarnat in 1976.
The Sarnat Score combines clinical and EEG findings (I, II, III = mild, moderate, severe). When using only clinical findings, this grading system is called the Modified Sarnat Score. The different stages are detailed below.
Mild HIE – Sarnat Stage I
- Hyper-alert
- Eyes wide open
- Does not sleep
- Irritable
- No seizures
- Usually lasts < 24 hours
Moderate HIE – Sarnat Stage II
- Lethargy (difficult to rouse)
- Reduced tone of the extremities and/or trunk
- Diminished brainstem reflexes (pupil/gag/suck)
- Possible clinical seizures
Severe HIE – Sarnat Stage III
- Coma (cannot be roused)
- Weak or absent respiratory drive
- No response to stimuli (may have spinal reflex to painful stimuli)
- Flaccid tone of the extremities and trunk (floppy)
- Diminished or absent brain stem reflexes (pupil/gag/suck)
- Diminished tendon reflexes
- EEG severely abnormal (suppressed or flat EEG with or without seizures)
Sarnat Cheat Sheet
Hello Sir,
we blessed with twin baby on 29.10.2015 , second baby was diagnosed HIE stage 2 to 3.
Cold treatment was given 3 days soon after birth. Baby started crying after a month only.
We are feeding by NG tube , what is the possibility rate that my child will be normal after few months.
And what kind of disability she will have in future and how to avoid it.
Advance thanks for your feedback.
Regards,
Vignesh S.
India
If features are mixing in stage like some are of stage 2 and some are of stage 3 how do you clasfy
I like it
Treatment of perinatal asphyxia according to sarnat and sarnat staging
What is management protocol of perinatal asphyxia according to sarnat and sarnat staging??
Hello,
Are medical facilities allowed to use this staging form or does it require a fee?
Is this something Cerner would have access to or is it proprietary?
Thanks,
Melany Blakemore
Sr. Solution Leader, Infection Control , Women’s and Children’s
mblakemore@cerner.com
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Thank you for the information provided. I have a question regarding the staging. A baby with HIE may show clinical features found in different stages of HIE. What criteria would you use to place this baby if the baby showed clinical features found in both stages (for example, baby has features found in both stage II and stage III)
Regards
Kodjo Arhin
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