This version was machine-translated from German and has not been medically reviewed. The authoritative version is the German version.

Hypoxic-ischemic encephalopathy: modified Sarnat stages and cooling criteria (NICHD)

Newborns from 36 weeks: grade of encephalopathy according to the 6 categories of the modified Sarnat criteria and check of the NICHD criteria for therapeutic hypothermia

Child

Gestational age (weeks)

Age (hours)

Blood gas and birth

pH (cord blood or blood gas from the first hour of life)

Base excess (BE), same sample (mmol/l)

Enter as negative: base deficit 16 mmol/l = BE −16.

Acute perinatal event (for example late or variable decelerations, umbilical cord prolapse, uterine rupture, hemorrhage, cardiac arrest)

Apgar at 10 minutes (optional)

Ventilation from birth, for at least 10 minutes

Seizures

Modified Sarnat criteria: 1 level of consciousness

1 consciousness

Modified Sarnat criteria: 2 spontaneous activity

2 spontaneous activity

Modified Sarnat criteria: 3 posture

3 posture

Modified Sarnat criteria: 4 muscle tone

4 muscle tone

Modified Sarnat criteria: 5 primitive reflexes

Sucking

Moro reflex

Modified Sarnat criteria: 6 autonomic nervous system

Pupils

Heart rate

Respiration

Calculation aid for healthcare professionals: the calculator reproduces what the sources cited assign to the inputs. Clinical assessment and every treatment decision remain with the treating physician. Inputs and results are not stored.

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Sources

Is It Time for a Randomized Controlled Trial of Hypothermia for Mild Hypoxic-Ischemic Encephalopathy? (J Pediatr 2020;220) Bates SV, Shankaran S, 2020. Overview, author manuscript read; table of the modified Sarnat criteria
Effect of depth and duration of cooling on deaths in the NICU among neonates with hypoxic ischemic encephalopathy: a randomized clinical trial (JAMA 312:2629–2639) Shankaran S, Laptook AR, Pappas A, et al.; Eunice Kennedy Shriver NICHD Neonatal Research Network, 2014. Randomized trial, full text read (PMC4335311); inclusion criteria
Childhood outcomes after hypothermia for neonatal encephalopathy (N Engl J Med 366:2085–2092) Shankaran S, Pappas A, McDonald SA, et al.; NICHD Neonatal Research Network, 2012. Follow-up study of the study by 2005, read; cooling 33.5 °C for 72 hours
Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy (N Engl J Med 353:1574–1584) Shankaran S, Laptook AR, Ehrenkranz RA, et al., 2005. Randomized trial (first description of the criteria), not freely readable

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Note

Calculation aid for healthcare professionals. Clinical assessment remains with the treating physician.

Review date of the German original: 2026-11-08 · Methodology

Frequently asked questions

Hypoxic-ischemic encephalopathy: modified Sarnat stages and cooling criteria (NICHD): What does this calculator compute?

In suspected hypoxic-ischemic encephalopathy (HIE, brain injury due to lack of oxygen during birth), assigns the findings to the 6 categories of the modified Sarnat criteria (NICHD Neonatal Research Network). Moderate or severe encephalopathy means: at least 3 categories moderate or severe. The calculator also checks the cooling criteria of the NICHD trials: from 36 weeks, up to 6 hours of life, blood gas (pH 7.0 or less, or base excess −16 mmol/l or lower) or an acute event with Apgar score or ventilation, plus encephalopathy or seizures. Cooling criteria differ between centers; the German GNPI guideline has not been reconciled.

Hypoxic-ischemic encephalopathy: modified Sarnat stages and cooling criteria (NICHD): Which sources is this calculator based on?

Bates SV, Shankaran S: Is It Time for a Randomized Controlled Trial of Hypothermia for Mild Hypoxic-Ischemic Encephalopathy? (J Pediatr 2020;220) (2020); Shankaran S, Laptook AR, Pappas A, et al.; Eunice Kennedy Shriver NICHD Neonatal Research Network: Effect of depth and duration of cooling on deaths in the NICU among neonates with hypoxic ischemic encephalopathy: a randomized clinical trial (JAMA 312:2629–2639) (2014); Shankaran S, Pappas A, McDonald SA, et al.; NICHD Neonatal Research Network: Childhood outcomes after hypothermia for neonatal encephalopathy (N Engl J Med 366:2085–2092) (2012); Shankaran S, Laptook AR, Ehrenkranz RA, et al.: Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy (N Engl J Med 353:1574–1584) (2005)