. Author manuscript; available in PMC: 2019 Apr 2.

Published in final edited form as: Pediatr Res. 2018 Sep 13;84(6):861–868. doi: 10.1038/s41390-018-0174-x

Table 1. Modified Sarnat scoring system for categorizing encephalopathy.

Each of the six main categories is assigned a score based on severity (0–3). When findings are common or overlapped in a category (Spontaneous activity and Suck overlap for mild and moderate HIE), the score assigned is one that corresponds to the level of consciousness.

Category	Normal (0)	Mild(1)	Moderate (2)	Severe(3)
Level of consciousness	Alert(responsive to external stimuli)	Hyper-alert (responsive to minimal stimuli)	Lethargic	Stupor/Coma
Spontaneous activity	Normal	Normal or decreased	Decreased	None
Posture	Predominantly flexed	Mild flexion of distal joints	Distal flexion or complete extension	Decerebrate
Tone	Strong flexor tone in all extremities	Normal or slightly increased	a. Hypotonia (focal or general)	Flaccid
Tone	Strong flexor tone in all extremities	Normal or slightly increased	b. Hypertonia	Rigid
Primitive reflexes
Suck	Strong, easily illicit	Weak or Incomplete	Weak or incomplete and/or bite	Absent
Moro	Complete	Intact (low threshold)	Incomplete	Absent
Autonomic Nervous System (ANS)
Pupils	Normal	Mydriasis	Myosis	Variable or Nonreactive
Heart rate	100–160 bpm	Tachycardia	Bradycardia	Variable
Respirations	Regular respirations	Hyperventilation	Periodic breath	Apnea or need ventilation