Sarnat Score (HIE Staging) — Pedianotes Tools

HIE Classification

Normal / Stage 0

Moderate/Severe Criteria

0 / 6 Categories

Therapeutic Hypothermia

Criteria Not Met

1. Level of Consciousness

2. Neuromuscular Tone

3. Spontaneous Posture

4. Primitive Reflexes (Suck / Moro)

5. Autonomic System (Pupils / HR / Resp)

6. Clinical Seizures / EEG

❄️ Therapeutic Hypothermia Eligibility Criteria (TOBY / NICHD Guidelines)

Whole-body cooling to 33.5°C ± 0.5°C for 72 hours must be initiated within 6 hours of birth.

Gestation ≥ 35 Weeks: Infant is ≥ 35+0 weeks at birth.

Age < 6 Hours: Postnatal age is within the 6-hour therapeutic window.

Perinatal Asphyxia Evidence: Cord/1h pH ≤ 7.00, Base Deficit ≥ 16, 10-min Apgar ≤ 5, or >10 min resuscitation.

Sarnat HIE Clinical Pearls:

Qualification for Therapeutic Hypothermia: Requires Gestation ≥ 35w + Age < 6h + Perinatal Asphyxia + ≥ 3 categories of Moderate (Stage 2) or Severe (Stage 3) Encephalopathy (or presence of clinical seizures).
Target Temperature: Maintain core rectal/esophageal temp at 33.5°C (33.0°C – 34.0°C) continuously for 72 hours, followed by slow rewarming at ≤ 0.5°C per hour.