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Sarnat stage II – moderate HIE — RACP Paediatrics MCQ

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ModerateNeonatalSarnat stage II – moderate HIERACP Paediatrics

A term neonate following perinatal asphyxia (cord pH 6.95, Apgar 2/4/6) at 3 hours of life is lethargic, has reduced tone, exaggerated reflexes, and is having clinical seizures. Pupils are constricted but reactive. The infant is breathing spontaneously. What is the Sarnat stage?

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Correct answer: A — Sarnat stage II (moderate)

Lethargy, reduced tone, exaggerated reflexes (hyperreflexia), seizures, and constricted pupils with maintained spontaneous respiration is Sarnat stage II (moderate HIE). This infant meets criteria for therapeutic hypothermia (≥35 weeks, ≤6 hours of age, evidence of perinatal asphyxia + moderate-severe encephalopathy). Cooling should be commenced targeting 33.5°C for 72 hours.

Reference: RCH Melbourne – 2023 – HIE CPG; ANZCOR – 2024 – Guideline 13.9