Tag Archives: cerebral palsy

Sarnat Grading Scale of HIE

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The Sarnat Grading Scale of HIE (Hypoxic-Ischemic Encephalopathy) is a scoring system used to grade the severity of an HIE injury.

Below is Alissa, the founder’s daughter, several days after birth.  She suffered severe HIE and is being tapped with a respiratory 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 accumulating in her lungs.   Also notice the cap on her head, she was kept warm from her birth.  Modern treatment is to place HIE infants into a cold state to slow down the metabolism and help prevent what is know as the “Cascade of Neurological Injury” that occurs in the first 48-72 hours after birth..

Alissa_NICU1

 

dr-sarnat
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)

photo credit: kudaker via photopin cc

A variety of chocolates.

High Calorie Foods/Drinks & Recipes

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Getting enough nutrition from food is a big challenge for children with cerebral palsy. Lack of motor skills and stomach issues result in a high percentage of children being malnourished and underweight. Choosing a high-calory diet is part of managing these feeding disorders in cerebral palsy.

High Calorie Yogurt brands

Liberty Brand – cals per 6oz 270 (Lemon), 250 (Vanilla), 280 (Coconut) Olympic Brand Krema – cals per 6oz 280 (Vanilla), 280 (Strawberry), 290 (Coconut), 270 (Lemon) Canned coconut milk – 445 calories per 1 cup serving (note: guar gum can be hard to digest) Super Pudding *4 servings of 365 cal each (1470 total calories) 2 cups whole milk 2 tablespoons oil 1 small package of Instant Pudding mix 3/4 cup dry milk powder OR 1 envelope Carnation Instant Breakfast (CIB) Powder Stir together milk powder (or CIB) and whole milk. Add instant pudding & oil and mix well. Pour into small dishes for 1/2 cup servings. Cover and refrigerate.

Fruit Smoothie

* 100 calories per cup, 1 gram protein 1 cup orange or pineapple juice 1 banana 1/2 cup canned pineapple or other fresh or canned fruit 1 tablespoon honey (optional) 4-5 ice cubes Put all in blender and process until smooth. Makes 1 (1cup) servings. Options: 1 cup coconut cream adds 100 cals per serving 1/4 cup peanut butter adds 190 cals, 8 grams protein per serving 1/2 cup ice cream adds 129 calories (Haagen Daz has 270 in half cup), 3 grams protein per serving.

Peanut Butter Honey Balls

*36 calories per ball, 2g protein 1/2 cup peanut butter 3 & 1/2 tbsp nonfat dry milk 1 to 2 tsp honey Combine ingredients and mix thoroughly. Roll into balls and refrigerate. Makes 24 balls of 1/2 tablespoon each. Substitute pediasure for milk for weight gain.  These were the doctors favorites and ones he recommended. He said to us to do one a day Chocolate-Peanut Butter Shakes 1/2 cup heavy whipping cream 3 tbsp creamy peanut butter 3 tsp chocolate ice cream Blend in blender Peaches and Cream 1 cup Milk 1 cup canned peaches 1 cup vanilla ice cream 1/4 tsp Salt 1/4 tsp Vanilla Blend in blender Apple Pie a la Mode 1 cup Apple pie filling 1/2 cup milk 1 cup vanilla ice cream Dash of Cinnamon Blend in blender.

High-Calorie Breakfast shake

1 cup half & half 1 packet of instant breakfast 3/4 cup Ice cream Blend in blender Grape Slush 2 grape juice bars 1 tbsp corn syrup 1/2 cup grape juice or 7-up 1 tbsp corn oil Blend in blender Grape Sherbet Shake 3/4  cup orange  sherbet 2 tbsp corn syrup 1/2  cup 7-up 2 tbsp corn oil Blend in blender Old Fashioned Milkshake 1 cup whole milk 1 cup ice cream Blend in blender Hot chocolate 3 oz. Milk chocolate 1/4  tsp vanilla 1 tsp butter 1 cup half & half Melt chocolate and butter. Add Vanilla and slowly stir in half & half. Small amounts at a time. Reheat to desired temperature.

Carnation Instant Breakfast

1 packet 1 cup whole milk Blend

Avocado pudding

2 ripe avocados 3/4 cup whole coconut milk 1 cup almond milk 8 pitted Medjool dates Instructions: In a blender, combine avocados, coconut milk, almond milk and dates. Chill for 2 hours and serve. Great garnished with whip cream photo credit: MarcelGermain via photopin cc