LAUSR

In 1976, Sarnat and Sarnat (1) published a study of twenty-one neonates with encephalopathy attributed to a “well-defined episode of fetal distress or an Apgar score of 5 or less at one or five minutes after delivery.” Their staging system for the sequential evolution of clinical signs and EEG changes was intended to facilitate formulation of prognosis for neurologic outcome (1). This descriptive study has endured over the decades because it was the first of its kind to propose a systematic approach to the common problem of neonatal encephalopathy, and because it is easily administered at the bedside. Modifications of the Sarnat Scoring System have been employed in the major trials of therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy (HIE) to identify neonates at highest risk for abnormal neurodevelopmental outcome (2). Today, 44 years later, the Sarnat score is a widely used tool worldwide to identify term neonates with encephalopathy, and particularly those who qualify for therapeutic hypothermia. Here we revisit the original article by Sarnat and Sarnat (1), including its purpose and limitations, present applications, and the need for ongoing adaptation and study.