A neonate born after emergency cesarean section for fetal distress has Apgar score 3 at 1 minute and 5 at 5 minutes. Cord pH is 7.00. At 6 hours of age, the baby has seizures, hypotonia, and absent Moro reflex. According to the modified Sarnat criteria for Hypoxic-Ischemic Encephalopathy (HIE), which GRADE is this and is this infant eligible for therapeutic hypothermia?
- A HIE Grade I (mild) — not eligible for cooling
- B HIE Grade II (moderate) — eligible for therapeutic hypothermia
- C HIE Grade III (severe) — eligible for therapeutic hypothermia ✓
- D HIE cannot be graded until 24 hours of life
Explanation
Modified Sarnat classification: Grade I (mild) = irritability, hyperalertness, mild hypotonia; Grade II (moderate) = lethargy, hypotonia, seizures, absent or incomplete Moro; Grade III (severe) = stupor/coma, profound flaccid hypotonia, seizures, absent all brainstem reflexes. This neonate has seizures, hypotonia, and absent Moro — Grade III HIE. Therapeutic hypothermia (whole-body cooling to 33–34°C for 72 hours) is indicated for moderate and severe HIE (Grades II and III) in term/near-term neonates ≥36 weeks gestation, within 6 hours of birth. Grade I does not warrant cooling. The clinical signs at 6 hours confirm Grade III.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.