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The Neurologic Exam for Neonates with Suspected Encephalopathy

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Encephalopathy is defined by the presence of one or more signs in at least three of the following six categories:

  • level of consciousness
  • spontaneous activity
  • posture
  • tone
  • primitive reflexes
  • autonomic nervous system

When findings are mixed, the extent of encephalopathy is determined by which category describes the majority of signs. If signs were equally distributed, categorize based on the level of consciousness.

Diagnostic Table 

 

Normal

Mild
Encephalopathy

Moderate Encephalopathy

Severe Encephalopathy

Level of consciousness

When awake, alert, fixes on visual stimuli
(see example)

Irritable, hyperalert, poor feeding, excess crying alternating with sleeping

Lethargic
(see example)

Stupor or coma

Spontaneous activity

Frequent spontaneous movements
(see example)

Increased, jittery
(see example)

Decreased activity

No activity
(see example)

Posture

Extremities flexed in toward the trunk
(see example)

Slight flexion, slight extension
(see example)

Distal flexion, complete extension
(see example)

Decerebrate

Tone

Normal
(see example)

Normal or slightly increased
(see example)

Hypotonia (focal
or general)
(see example)

Flaccid
(see example)

Primitive reflexes
   Suck

Strong coordinated suck
(see example)

Uncoordinated

Weak or unsustained
(see example)

Absent
(see example)

Primitive reflexes
   Moro

Complete moro
(see example)

Exaggerated

Incomplete

Absent

Autonomic system
   Pupils

Reactive

Dilated

Constricted

Deviated, dilated, or nonreactive to light

Autonomic system
   Heart rate

Normal

Tachycardia

Bradycardia

Variable (heart rate is not constant and varies widely)

Autonomic system
   Respiration

Normal

Regular

Periodic breathing

Apnea

 

This is a beta version of this site. It is intended as an educational resource and not to replace clinical judgement. For questions and feedback please contact Wusthoff(at)stanford.edu