Sarnat Staging for HIE: Severity of Newborn Brain Injury from a Lack of Oxygen

One method that physicians use to gauge the severity of brain injury to a newborn or neonate from a lack of oxygen injury (i.e., hypoxic-ischemic injury), is the “Sarnat Staging System.”  This staging criteria was first set forth by the husband and wife physician team – Dr. Harvey Sarnat and Margaret Sarnat, back in the mid-1970’s. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7704551/  They sought to explore the correlation between a severe lack of oxygen to a newborn or neonate. sometimes referred to as: “HIE” (hypoxic-ischemic encephalopathy), and long term neurologic outcome.

The Sarnat Staging System, is currently used by neonatologists and health care providers around the world to provide a “snapshot” of the severity of neonatal encephalopathy in the first six (6) hours of life.  This system scores infants based upon: Level of Consciousness; Pupil Dilation/Constriction; Tone; Reflexes; Seizures (clinical evidence); an EEG; & the initial Apgar score the infant received at one (1) and five (5) minutes after delivery.  The test results place the infant/neonate into one of three (3) categories which are referred to as a: Stage I (least severe), Stage II (some significant findings of injury, including an abnormal electro-encephalogram – EEG); & Stage III (severe neurologic injury being present clinically and upon testing).   

Time has shown that a Sarnat Score in the Stage III category is strongly associated with long term neurologic injury and even cerebral palsy.  Early treatment for Stage III Sarnat scored infants, such as hypothermic therapy (i.e., brain or body cooling in the first 72 hours of life) is vitally important for the best possible long term neurologic outcome.