LAUSR

Introduction ‘Neurophobia’, the fear of clinical neurology by physicians, is widely acknowledged in the literature. The Sarnat Score is essential for the clinical designation of the severity of encephalopathy in neonatal patients. A recent review of therapeutic hypothermia cases (n=140) in the Republic of Ireland (2016–2017), highlighted incomplete documentation of the Sarnat Score in neonates with encephalopathy. On the first day of treatment, posture, tendon reflexes, tonic neck and moro reflexes were undocumented for 70%, 66%, 95%, and 64% of cases respectively. Level of consciousness, motor activity, muscle tone, pupil size and reaction to light were similarly inadequately documented. This quality improvement initiative aimed to educate doctors in a tertiary neonatal unit regarding the importance of systematic evaluation and documentation of neonatal encephalopathy using the Modified Sarnat Score. Methods An education session for all medical staff working in the neonatal unit was held, outlining the importance of appropriate use and documentation of the Sarnat Classification in clinical practice. Index cards were issued to all staff, describing the individual components of the score and those techniques necessary to elicit the relevant neurologic signs. A teaching video, demonstrating neurological assessment of a neonate using the Modified Sarnat Score, was recorded and uploaded to the official hospital website. Anonymous questionnaires were obtained to assess effectiveness of teaching. Results In total, 17 Healthcare Professionals attended the education session, with a mean of 8 years experience working in Paediatrics. 58% (n=10) had previously received education on the Sarnat Score. 47% (n=8) had used the Sarnat Score previously in clinical practice. Lack of formal training on the score was the main reason cited amongst those who had not used the score previously. 23% (n=4) correctly identified the individual components of the score prior to education. 12% (n=2) correctly scored ≥80% of the clinical scenarios provided. Following education, 71% (n=12) correctly scored ≥80% of the clinical scenarios provided. All staff (n=17) found the education session informative, and felt more confident using the Sarnat Score following the session. 58% (n=10) felt that further education on the Sarnat Score was required. Conclusion It is recognised that the neurological assessment of infants is challenging, particularly for inexperienced clinicians. The validated Sarnat classification system is a valuable resource in the clinical assessment of neonates with encephalopathy. This clinical tool provides physicians with a standardised approach to systematic neurological examination and documentation of pertinent neurological findings.