Classification of neonatal encephalopathy (NICHD neurological examination)
| Categories (total 6) | Signs of NE in each category (circle the most appropriate level) | |||
| Normal | Mild NE | Moderate NE | Severe NE | |
| 1. Level of consciousness | ||||
| Alert, responsive to external stimuli (state dependent, eg, postfeeds) | Hyperalert, has a stare, jitteriness, high-pitched cry, exaggerated responds to minimal stimuli, inconsolable | Lethargic | Stupor/coma | |
| 2. Spontaneous activity | ||||
| Changes position when awake | Normal or decreased | Decreased activity | No activity | |
| 3. Posture | ||||
| Predominantly flexed when quiet | Mild flexion of distal joints (fingers, wrist usually) | Moderate flexion of distal joint, complete extension | Decerebrate | |
| 4. Tone | ||||
| Strong flexor tone in all extremities+strong flexor hip tone | Normal or slightly increased peripheral tone | Hypotonia (focal or general) or hypertonia | Flaccid rigid | |
| 5. Primitive reflexes (circle only the highest level in each sign; the maximum score is only one in any one category) | ||||
| Suck | Strong, easily illicit | Weak, poor | Weak but has a bite | Absent |
| Moro | Complete | Partial response, low threshold to illicit | Incomplete | Absent |
| 6. Autonomic system (circle only the highest level in each sign; the maximum score is only one in any one category) | ||||
| Pupils | In dark: 2.5–4.5 mm In light: 1.5–2.5 mm | Mydriasis | Constricted | Deviation/dilated/non-reactive to light |
| Heart rate | 100–160 bpm | Tachycardia (HR >160) | Bradycardia (HR <100) | Variable HR |
| Respiration | Regular respirations | Hyperventilation (RR >60/min) | Periodic breathing | Apnoea or requires ventilator |
| Total score | ||||
| *Seizure | None | None | Yes/no | Yes/no |
Infant who has seizure will be moderate or severe NE depending on the neurological exam. Seizure with normal or mild NE or moderate NE on neurological exam will be ‘moderate NE’. Seizure with severe NE will be ‘severe NE’. The level of encephalopathy will be assigned based on which level of signs (moderate or severe) predominates among the six categories. If moderate and severe signs are equally distributed, the designation is then based on the highest level in category no 1: the level of consciousness.
HR, heart rate; NE, neonatal encephalopathy; NICHD, National Institute of Child Health and Human Development; RR, regular respiration.