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Severity of neonatal encephalopathy, based on modified Sarnat Scoring System

Severity of neonatal encephalopathy, based on modified Sarnat Scoring System
Category Normal Mild abnormality Moderate abnormality Severe abnormality Unable to assess
  1. Level of consciousness
 Normal Hyperalert or irritable Lethargic or poorly responsive Minimal or no responsiveness NA
  1. Spontaneous activity
 Normal Slightly decreased Decreased Absent NA
  1. Posture
 Normal Mild distal flexion Distal flexion, complete extension Decerebrate NA
  1. Tone
 Normal Hypertonic Hypotonic Flaccid NA
  1. Primitive reflexes
    1. Suck
 Normal NA Weak or bite Absent Unable to assess
    1. Moro
 Normal Low threshold to elicit Weak or incomplete Absent Unable to assess
  1. Autonomic
    1. Pupils
 Normal NA Constricted Dilated and either fixed or sluggishly reactive; asymmetric NA
    1. Respiration
 Normal NA Periodic breathing Intubated and ventilated NA
  • Encephalopathy: at least three of six criteria present.
  • Severe: more symptoms in the severe than moderate column.
  • Moderate: more symptoms in the moderate column.
  • Mild: more symptoms in the mild column. If encephalopathy signs are equally distributed between mild, moderate, and severe categories, the severity of encephalopathy is based upon level of consciousness[1].
NA: not applicable.
Adapted from: Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study. Arch Neurol 1976; 33:696.
Additional information from:
  1. Shankaran S, Laptook AR, Ehrenkranz RA, et al. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353:1574.
  2. Wu YW, Mathur AM, Chang T, et al. High-Dose Erythropoietin and Hypothermia for Hypoxic-Ischemic Encephalopathy: A Phase II Trial. Pediatrics 2016; 137:e20160191.
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