Sarnat staging explainer
The short answer
Sarnat staging is a three-stage scale doctors use to describe how severe a newborn brain injury looks in the first hours. Stage 1 is mild, stage 2 is moderate, stage 3 is severe. 1
The stage is set by examining the baby, not by a scan. It matters because it decides whether therapeutic hypothermia is offered, and cooling is started within six hours of birth. 2
The numbers, up front
- Where it comes from
- A staging system described by Sarnat and Sarnat in 1976, still in use 1
- How the stage is set
- By examining the baby: alertness, tone, reflexes, posture, pupils, heart rate and breathing. Not by a scan 1
- Why it matters
- Cooling is offered for moderate or severe encephalopathy in babies at or near term, started within six hours of birth 2
- The stage can change
- It is assigned in the first hours and can change, which is why the time it was recorded matters 1
- What predicts more
- The MRI findings and the EEG background between seizures predict outcome better than the stage alone 3
This tool runs entirely in your browser. Nothing you type is sent anywhere, stored on any server, or seen by anyone including us. There is no analytics on this page. Nothing is saved when you close the page. You can check this yourself: turn off your internet connection and the tool still works.
Three things to ask
Which stage was recorded, and at what time? The stage can change over the first hours, so the time matters.
Was cooling considered, what was decided, and at what time? Ask for the answer to be written in the chart. 2
What did the MRI show? The imaging predicts outcome better than the stage does. 3
See HIE for the full picture.
Questions parents ask
My baby was stage 2. What does that mean for the future?
Moderate encephalopathy covers a wide range of outcomes, from no lasting effects to significant disability. It is also the group in which cooling has the clearest benefit. 2 The MRI findings in the first two weeks predict outcome better than the stage or the birth history. 3
Why was my baby not cooled?
Cooling is offered for moderate or severe encephalopathy in babies at or near term, started within six hours of birth. 2 Babies with mild encephalopathy are usually not cooled. Ask directly: was it considered, who decided, what time, and on what basis.
Can the stage change?
Yes. It is assigned in the first hours based on examination and it can change as the baby's condition evolves. That is why the recorded time matters as much as the number. 1
Words on this page, in plain English
- Sarnat staging
- A three-stage scale doctors use to describe how severe a newborn brain injury looks in the first hours. Stage 1 is mild, stage 2 is moderate, stage 3 is severe.
- therapeutic hypothermia
- Cooling a newborn's body to about 33.5 degrees Celsius for 72 hours to limit brain injury after a loss of oxygen. It is started within six hours of birth.
Where these facts come from
- Archives of Neurology. Neonatal Encephalopathy Following Fetal Distress: A Clinical and Electroencephalographic Study. 1976. pubmed.ncbi.nlm.nih.gov/987769/. Link checked September 3, 2026.
- Cochrane Database of Systematic Reviews. Cooling for newborns with hypoxic ischaemic encephalopathy. 2013. www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003311.p. Link checked September 3, 2026.
- Elsevier. Volpe's Neurology of the Newborn, Sixth Edition. 2018. www.elsevier.com/books/volpes-neurology-of-the-newborn/volpe. Link checked September 3, 2026.