Animated explanation of "Expanded modified SARNAT staging" and a brief overview of COMET inclusion

Clinical trials normally have an objective inclusion criterion. However, neuroprotection studies for
hypoxic ischemic encephalopathy have a tiered inclusion criteria where objective markers followed by a
neurological examination. Several factors like maternal anaesthesia, severity and timing of brain injury
and evolution, compensatory hemodynamic mechanisms and endogenous neuroprotective mechanisms
can affect the neurological assessments. Although neurological examination is a subjective assessment,
standardisation of the assessment and certification minimises examiner variability and promotes
enrolment of appropriate babies.
Use this document to complete the neurological assessment table. There are 9 signs under 6 categories
in the Expanded Modified Sarnat staging. Four of these signs can be assessed by observing the baby in an
awake state and five signs requires active manipulation of the baby.