Clinical staging of hie sarnat grading scale of hie sarnat and sarnat, 1976 mild hie sarnat stage i hyperalert eyes wide open does not sleep irritable no seizures usually lasts of the body, but hypoxicischemic encephalopathy hie is the most studied clinical condition and that exhibiting the most serious sequelae. Hypoxic ischemic encephalopathy hie is one of the most serious birth complications affecting full term infants. Term neonates were included in the study if they satisfied at least criteria 1 and 3. Hypoxic ischemic encephalopathy ashraf baeshu, md objectives describe the condition of perinatal asphyxia. Neonates with suspected hie are classified according to the sarnat staging system, which divides neonates into mild, moderate, or severe categories, and measures the. For scopus and web of science only free text was applied.
Correlation of renal function with severity of hypoxic ischemic. Sarnat and sarnat classification was used for grading of the hie table1. Association between newborn screening analytes and hypoxic. The aim was to determine the selected maternal and fetal risk factor for adverse shortterm outcomes in babies with birth asphyxia. Twentyone neonates of over 36 weeks gestation suffered perinatal asphyxia but not chronic hypoxia. The scoring system is divided into stage 1 mild, stage 2 moderate and stage 3 severe. Neonatal hypoxicischemic encephalopathy hie is a serious brain injury resulting. Although sarnat staging is a useful diagnostic tool, its predictive value is.
Therapeutic hypothermia for neonatal hypoxicischemic. The clinical hie grade combined with other measures, e. Mar 17, 20 early evaluation of hie early and repeated clinical examination. Stage 1mild stage 2moderate stage 3severe level of consciousness normal lethargicobtunded.
This is a pdf file of an unedited manuscript that has been accepted for publication. Ascorbic acid combined with ibuprofen in hypoxic ischemic. The neonates status may progress over hours to days depending on the severity of the insult. Longterm outcomes of hypoxicischemic encephalopathy. The sarnat chart for the staging of the severity of hypoxic ischemic. Other terms used for hie include birth asphyxia, perinatal asphyxia, and neonatal. A simple and practical classification of hie by severity of manifestations provided by levene is recommended for routine use table 28. Four patients, all of whom had stage 3 hie, died during followup. Of the following, the criterion most consistent with the diagnosis of mild hie is. As per sarnat and sarnat staging 2420% were in stage 1, 3630% were in stage 2 and 2016. Staging of hie based on the modified sarnat classification sarnat 1976 variable stage i stage ii stage iii level of consciousness alert lethargic comatose muscle tone normal or hypertonic hypotonic flaccid tendon reflexes increased increased depressed or. Assistant professor of pediatrics, division of neonatology, vanderbilt university medical center, nashville, tn. A staging procedure designed by sarnat and sarnat for hypoxic ischemic encephalopathy may be helpful to determine the severity of the asphyxial event and suspected long term outcome based upon their findings.
Median apgar score at 1 minute is 3 each in room air and 100% oxygen group as per table ii, whereas in the text it has been stated that room air group had significantly higher 1 minute apgar score than 100% oxygen. All cases of hie, including the most mild cases identified using the sarnat staging criteria, would have been included in our cases, and previous. Severity of hie sarnat chart for the staging of severity of hie sarnat h. The original paper on the sarnat score was based on 21 newborns over 36 weeks gestation suffering from perinatal asphyxia. Randomized clinical trials rcts have demonstrated its safety in neonates with hypoxicischemic encephalopathy hie. Jul 18, 2018 the staging system proposed by sarnat and sarnat in 1976 is often useful in classifying the degree of encephalopathy. In essence, you are free to copy and communicate the. Modified sarnat scale for clinical encephalopathy staging. With sarnat and mri findings alone we were able to predict motor outcome slightly better than mental outcome. The severity of hie can be graded as mild, moderate, or severe, using a classification proposed by sarnat and sarnat. Other than neurological dysfunction symptoms which were also associated in asphyxiated newborn were feeding difficulties75%, respiratory distress 25%, meconium aspiration syndrome.
Of the 44 neonates admitted to the neonatal unit with hie, they were categorised by sarnat staging as. A simpler and practical classification of hie by severity of manifestations provided by levene et al is recommended for routine use table 28. Within the hie group, there was no significant correlation between nrbc count and first ph, first lactate, or 5 minute apgar score. Stages i, ii, and iii correlate with the descriptions of mild, moderate, and. Hie may result in brain damage with neurodevelopmental delay, cerebral palsy, or epilepsy 27. Three clinical stages of postanoxic encephalopathy were distinguished. Health care providers also use the sarnat staging criteria or an. The aim of this study was to investigate whether motor testing at 1 year could improve the accuracy of the prediction of motor and mental outcome at 2 years after hie, especially in children with sarnat grade ii and abnormal mri. Sarnat staging of encephalopathy moderatesevere encephalopathy will be defined as either clinical seizures or the presence of 3 of 6 categories from moderate or severe column in table 1 below. Neonatal encephalopathy and its subset of hypoxicischaemic encephalopathy hie are defined. Sarnat score cheat sheet dr sarnat modified version share this. Hypoxicischemic encephalopathy hie is a type of newborn brain damage caused by oxygen deprivation and limited blood flow. In medicine sarnat staging, sarnat classification or the sarnat grading scale is a classification scale for hypoxicischaemic encephalopathy of the newborn hie, a syndrome caused by a lack of adequate oxygenation around the time of birth which manifests as altered consciousness, altered muscle tone, and seizures. Neonatal and pediatric medicine correlation of renal function with severity of hypoxic ischemic encephalopathy hie in egyptian full term neonates.
Hie clinical features, investigations and management. The median nrbc count was significantly different across each of the three study groups. Twenty apparently healthy full term neonates delivered in minia university hospital selected as a control group group ii and. Infants with hie present with neurological symptoms, whose severity is classified based on the modified sarnat staging see table below. The staging system proposed by sarnat and sarnat in 1976 is often useful in classifying the degree of encephalopathy. Mild hie group of babies would not benefit from this intervention but jacobs et al8 showed that the. Infants with hie present with neurological symptoms, whose severity is. Professor of pediatrics, section of neonatology, childrens mercy hospital, kansas city, mo. Stage 1 has a duration of less than 24 hours and consists of hyperalertness with a normal moro, normal stretch reflexes, normal sympathetic effects and a normal eeg. Intrapartum fetal hypoxia followed by hypoxic ischemic encephalopathy hie is a common cause of potentially avoidable brain injury in term infants 1,2. Evolution of hie changes hypoxicischemic brain damage is a gradually evolving process, which begins during the. Stages i, ii, and iii correlate with the descriptions of mild, moderate, and severe encephalopathy described above. Sarnat scoring tool normalmild moderate hie severe hie 1.
Therapeutic hypothermia for hypoxic ischaemic encephalopathy. Professor emerita of psychology, depaul university. Severity of the hie neonates suspected with hie are classified according to the modified sarnat and sarnat staging figure 3. According to the modified sarnat and sarnat staging system,11 16 40. There may be evidence of other endorgan damage such as coagulopathy, raised liver enzymes, acute renal failure, hypotension, persistent foetal circulation andor respiratory failure. Apr 28, 2011 to determine whether phenobarbital pb given before therapeutic hypothermia to infants with hypoxicischemic encephalopathy hie augments the neuroprotective efficacy of hypothermia. Early clinical signs in neonates with hypoxic ischemic. Neonatal therapeutic hypothermia a wasunna professor of neonatal medicine and pediatrics school of medicine, university of nairobi. Stage 2 infants are obtunded, hypotonic, with strong. Jul 16, 2016 sarnat and sarnat staging stage i, ii and iii thompson scoring. Is there a way to predict outcome in near term neonates. Correlations between maternal and neonatal serum selenium. The modified sarnat score in the assessment of neonatal.
Postresuscitation management of asphyxiated neonate. The decreased ability of the neonatal brain to eliminate free radicals. During this initial evaluation, hie was classified into mild, moderate and severe grades using sarnat and sarnat staging. Sarnat and sarnat classification of hie grading stage 1 stage2 stage3 level of consciousness hyper alert lethargic or obtunded stuporous. Download table the sarnat chart for the staging of the severity of hypoxic ischemic encephalopathy as introduced by sarnat h. Hypoxicischemic encephalopathy clinical presentation.
Seizures often associated with moderate andor severe stages. The queensland clinical guideline hypoxicischaemic encephalopathy hie is the primary reference for this package. Early evaluation of hie early and repeated clinical examination. This table showed that means of serum creatinine were significantly increased with the increase in severity of hie according to sarnat and sarnat staging.
Relation of serum creatinine to sarnat scoring and brain. Jul 18, 2018 despite major advances in monitoring technology and knowledge of fetal and neonatal pathologies, perinatal asphyxia or, more appropriately, hypoxicischemic encephalopathy hie, remains a serious condition that causes significant mortality and longterm morbidity. Motor testing at 1 year improves the prediction of motor. Grading of perinatal asphyxia by clinical parameters and. Management monitoring vitals urine output blood sugar monitoring hematocrit pcv electrolytes assessment of neurological status 6 hourly tone. Sarnat stage i is considered mild, hie, stage ii moderate, and stage iii severe 1. In essence you are free to copy and communicate the work in its current form for noncommercial purposes, as long as you attribute the authors. The assessed elements included level of consciousness, muscle tone, muscle tendon and tendon reflexes, seizures, autonomic function, and electroencephalogram description. Sometimes, physicians use sarnat staging to determine the severity of hie. Motor testing at 1 year improves the prediction of motor and. Staging of hie based on the modified sarnat classification sarnat.
Hypoxic ischaemic encephalopathy queensland health. There were significant relationships for sarnat and sarnat clinical s tag ewih eg p 0. Pdf neonatal and pediatric medicine correlation of renal. Table 4 showed relation between serum creatinine and findings of ct brain among studied cases, there was statistically significant difference among serum. What are the sarnat clinical stages of hypoxicischemic. Hypoxicischaemic encephalopathy hie queensland health. Hypoxic ischemic encephalopathy hie is a serious birth. This process takes into consideration exam results, clinical presentation, presence of seizures and duration of illness. Download table modified sarnat scale for clinical encephalopathy staging from. Predictors of hypoxic injury the seminal work by sarnat and sarnat is considered the baseline or criterion standard for the measurement of hie.
Does phenobarbital improve the effectiveness of therapeutic. Sarnat staging considers clinical presentation, exam results, illness duration, and whether the baby has seizures. The queensland clinical guideline hypoxicischaemic encephalopathy hie is the. There may be evidence of other endorgan damage such as coagulopathy, raised liver enzymes, acute renal failure, hypotension, persistent foetal circulation and or respiratory failure.
Hypoxicischaemic encephalopathy hie refer to online version, destroy printed copies after use page 6 of 27 flowchart. Severity of hypoxic ischemic encephalopathy and heart rate. Hie is a brain injury that prevents adequate blood flow to the infants brain occurring as a result of a hypoxicischemic event during the prenatal, intrapartum or postnatal period. As regard resuscitation steps among studied groups, the use of free oxygen flow and ett. Postresuscitation management of asphyxiated neonates. For hie progression and prognostic scoring quantitative 23. Thomson score is based on features of hie and it can have a maximum worst score of 22. Neonatal hypoxia and seizures american academy of pediatrics. To determine whether phenobarbital pb given before therapeutic hypothermia to infants with hypoxicischemic encephalopathy hie augments the neuroprotective efficacy of. Two methods of cooling that have been evaluated so far are whole body and selective. Stage 1 lasted less than 24 hours and was characterized by hyperalertness, uninhibited moro and stretch reflexes, sympathetic effects, and a normal. This was a prospective observational study, including all birth asphyxiated babies born between january 1, 20 and december 1, 20 who fulfill the inclusion criteria. Review the diagnosis and management of hypoxic ischemic encephalopathy hie know staging of hie understand the benefits and outcomes of cooling for the treatment of hie. Clinical staging of hie sarnat grading scale of hie sarnat and sarnat, 1976 mild hie sarnat stage i hyperalert eyes wide open does not sleep irritable no seizures usually lasts distress.
Sarnat chart for the staging of severity of hie sarnat h. The stages in this table reflect the clinical state of infants over 36 weeks gestational age. Cooling is said to be more beneficial in the moderate hie group than the severe hie group. Although sarnat staging is a useful diagnostic tool, its predictive value is somewhat limited, and it should be used in. Other terms used for hie include birth asphyxia, perinatal asphyxia, and neonatal encephalopathy. The assessed elements included level of consciousness, muscle tone, tendon and complex reflexes, seizures, autonomic function and electroencephalogram eeg description. Hypoxic ischaemic encephalopathy hie page 2 of 5 neonatal guideline table. Hypoxicischaemic encephalopathy hie c linical guideline education presentation e16. Sep 01, 2011 hie is a brain injury that prevents adequate blood flow to the infants brain occurring as a result of a hypoxicischemic event during the prenatal, intrapartum or postnatal period. Detailed maternal information and progress of babies were. In medicine sarnat staging, sarnat classification or the sarnat grading scale is a classification scale for hypoxicischaemic encephalopathy of the newborn hie, a syndrome caused.
Hie is graded based on the infants clinical presentation, examination findings. Hie caesarean section medicine free 30day trial scribd. Depending on the neurobehavioral signs neonates were divided in three stages 1, 2 and 3. The rhoda and bernard sarnat international prize in mental health was established in 1992 and is awarded annually by the national academy of medicine in the united states to recognize individuals, groups, or organizations for outstanding achievement in improving mental health. Hie was defined as mild, moderate, or severe using the sarnat and sarnat staging system. Apr 10, 20 intrapartum fetal hypoxia followed by hypoxic ischemic encephalopathy hie is a common cause of potentially avoidable brain injury in term infants 1,2. The incidence of hie in developed countries is estimated to be 1. With 1 to 3 in 1,000 term neonates experiencing seizures, pediatricians need to know how to determine the seizure cause and manage appropriately, using brain imaging and treatments such as therapeutic hypothermia, xenon, and other pharmacologic therapies, in order to minimize longterm sequelae and leverage the infant brains tremendous capacity for repair in the first 2 years.1504 588 239 1612 976 1635 1115 563 1003 102 826 713 413 984 1251 672 855 1378 158 497 918 1084 628 1073 274 749 179 710 1062 221 1054 224 681 746 141 546 21 55 511 1361 1320 883 1271 1463 963