According to Sarnat and Sarnat staging, which clinical sign is characteristic of Stage 2 (moderate) hypoxic-ischaemic encephalopathy in neonates?

Explanation

## Sarnat and Sarnat Staging of HIE **Key Point:** The Sarnat and Sarnat classification divides HIE into three stages based on clinical neurological signs, with Stage 2 (moderate encephalopathy) characterized by seizures, pupillary abnormalities, and altered consciousness. ### Sarnat Staging Classification | Stage | Level of Consciousness | Muscle Tone | Seizures | Pupillary Changes | Reflexes | Prognosis | |-------|------------------------|-------------|----------|-------------------|----------|----------| | **Stage 1 (Mild)** | Hyperalert | Normal/hyperreflexia | None | Normal | Brisk | Good; minimal sequelae | | **Stage 2 (Moderate)** | Lethargy/obtundation | Hypotonia | **Present** | **Miotic** | Weak | Variable; risk of sequelae | | **Stage 3 (Severe)** | Comatose | Flaccid | Seizures then absent | Fixed/dilated | Absent | Poor; high mortality/disability | **High-Yield:** Stage 2 HIE is the target population for therapeutic hypothermia. Seizures typically emerge 6–48 hours after birth in moderate encephalopathy and are a key diagnostic feature. **Clinical Pearl:** Miotic (constricted) pupils in Stage 2 reflect brainstem involvement but are reversible with treatment, whereas fixed and dilated pupils in Stage 3 indicate severe, often irreversible damage. **Mnemonic for Stage 2 Features:** **SLUMP** — Seizures, Lethargy, Unusual tone (hypotonia), Miotic pupils, Poor reflexes. [cite:Nelson Textbook of Pediatrics 21e Ch 107]