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The following is a summary of “Prediction of 18 to 22 Month Neurodevelopmental Outcomes Using the Numerical Sarnat Score Compared with Modified Sarnat Staging in Infants with Moderate to Severe Hypoxic-Ischemic Encephalopathy,” published in the February 2025 issue of Journal of Pediatrics by Natarajan et al. 

Researchers conducted a retrospective study to compare the numerical Sarnat score (NSS) and modified Sarnat staging in predicting neurodevelopmental outcomes at 18 to 22 months in infants with moderate/severe hypoxic-ischemic encephalopathy. 

They analyzed participants with gestational age ≥36 weeks and moderate/severe HIE from the Hypothermia (IH) and Optimizing Cooling (OC) trials. They performed early (<6 hours) neurologic exams using modified Sarnat staging. They calculated the NSS by summing abnormal scores (2 for moderate, 3 for severe) across 6 categories. They assessed death or moderate/severe disability as the primary outcome. They used logistic regression, adjusting for center, trial, and cooling group, and linear regression for continuous scales. 

The results showed that among 528 infants, 71% had moderate and 29% had severe HIE (37% IH, 63% OC). Median (IQR) NSS was 11 (9-13) for moderate and 16 (16-17) for severe HIE. NSS, NSS tertiles, and modified Sarnat staging were significantly associated with death or disability, but their AUC estimates showed no differences. NSS, like modified Sarnat staging, was significantly associated with Bayley-III cognitive, language, and motor scores and Bayley-II mental and psychomotor developmental indices. 

Investigators found that NSS did not improve the predictive accuracy for death or disability at 18 to 22 months compared to modified Sarnat staging performed within 6 hours of birth. 

Source: jpeds.com/article/S0022-3476(25)00062-9/abstract