Understanding HIE Prognosis and Intervention

Quick take: Mild, moderate, and severe hypoxic‑ischemic encephalopathy (HIE) each carry distinct short‑ and long‑term outlooks. Mild HIE usually resolves with normal development, moderate HIE carries a 60‑80% chance of neurodevelopmental impairment despite treatment, and severe HIE has a 20‑30% survival rate with a high likelihood of severe disability. Therapeutic hypothermia started within six hours is the only proven acute therapy, and ongoing rehabilitation can improve function at any stage.

It’s 2 a.m., you’re in the NICU hallway, the monitor’s soft beeping mixes with the rustle of blankets, and the nurse just whispered the word “HIE.” Your heart races. You’ve read the term online, but the medical jargon feels overwhelming, and you need a clear answer—right now. You’re not alone. Many parents face the same moment of uncertainty, and the good news is that the path forward is well‑charted, even if the terrain looks steep.

In this guide we break down everything you need to know about hypoxic‑ischemic encephalopathy—from what it is and why it happens, to how each severity level (mild, moderate, severe) shapes a baby’s prognosis, and what immediate and long‑term interventions can make a difference. We’ll also point you to resources, answer common questions, and give you a checklist of red‑flag signs that require urgent medical attention.

By the end of this article you’ll understand the range of outcomes, the role of therapeutic hypothermia, the importance of early rehabilitation, and how to advocate for the best possible care for your newborn. We understand that this is an incredibly challenging time, and we're here to provide clarity and comfort as you navigate your child's journey.

What is HIE and what causes it?

Hypoxic‑ischemic encephalopathy (HIE) is a type of brain injury that occurs when a baby’s brain doesn’t get enough oxygen and blood flow around the time of birth. The lack of oxygen (hypoxia) and reduced blood supply (ischemia) can damage neurons, the brain’s communication cells, leading to a spectrum of neurological problems.

The injury unfolds in three overlapping phases. The primary phase is the actual oxygen shortage, which can happen in seconds. The secondary phase, occurring hours later, involves a cascade of excitatory neurotransmitters, free‑radical formation, and inflammation that can expand the area of damage. Finally, a tertiary phase of remodeling may continue for weeks, influencing long‑term outcomes. Understanding these phases helps clinicians target therapies like cooling, which aim to blunt the secondary cascade. The timing and duration of these phases are critical, influencing both the extent of initial injury and the effectiveness of therapeutic interventions.

Common triggers include:

• Uterine rupture or severe placental abruption
• Prolonged or complicated labor (e.g., cord prolapse, severe maternal hypotension)
• Maternal cardiac arrest, severe hemorrhage, or respiratory failure
• Late‑preterm birth with poor transition to breathing
• Infections that impair oxygen delivery (e.g., chorioamnionitis)

Not every baby who experiences a brief dip in oxygen will develop HIE. The degree of injury depends on how long the oxygen shortage lasts, how low the oxygen levels drop, and the baby’s ability to recover. Early identification and swift treatment are critical because brain cells can die within minutes of severe oxygen deprivation. While many cases are linked to events around birth, some may originate prenatally, making precise timing of the injury a complex diagnostic challenge.

How is HIE staged?

Clini

Beyond the bedside exam, objective tools sharpen the picture. Amplitude‑integrated electroencephalography (aEEG) can detect subclinical seizures within the first 24 hours, while magnetic resonance imaging (MRI) performed between days 3‑5 captures patterns of injury that correlate with later disability. Blood biomarkers such as S100B protein and lactate are also being studied as early indicators, though they are not yet standard of care. These advanced diagnostics provide crucial information that helps confirm the diagnosis and refine the prognosis beyond the initial clinical assessment.

If you’re trying to understand where your newborn falls on this scale, the Sarnat HIE Staging calculator can be a helpful tool to translate clinical findings into a clear stage.

Prognosis for mild HIE

“Mild” HIE (stage 1) is characterized by slight irritability, a normal or mildly reduced muscle tone, and no seizures. Most infants recover within the first 48 hours, and neuroimaging (MRI) often shows little or no injury. The short‑term outlook is generally reassuring:

• Neonatal seizures are rare (less than 5% of mild cases).
• Average hospital stay is 4–6 days, similar to uncomplicated newborns.
• Feeding and weight gain typically normalize quickly.

Long‑term studies, including follow‑up cohorts from the American Academy of Pediatrics (AAP) and the United Kingdom’s NICE guidelines, show that 85‑95% of children with mild HIE achieve normal developmental milestones through age 5. A small minority (roughly 5‑10%) may develop subtle language or attention difficulties that become apparent in school, but these issues are usually manageable with early intervention. These children often benefit from developmental surveillance and, if needed, targeted support through school-based programs or private therapy.

Key factors that improve the prognosis for mild HIE include:

1. Prompt identification and supportive care (maintaining normal temperature, glucose, and oxygen levels).
2. Absence of seizures or persistent abnormal reflexes.
3. Normal MRI findings or only transient signal changes.

Because the brain injury is minimal, therapeutic hypothermia is generally not indicated for mild HIE, but clinicians will still monitor the baby closely for any change in neurological status. Ongoing developmental surveillance at 6‑month and 12‑month intervals helps catch the occasional late‑emerging concern, ensuring that any subtle challenges are addressed proactively.

Prognosis for moderate HIE

Moderate HIE (stage 2) presents with lethargy, reduced spontaneous movements, and a higher likelihood of seizures. Brain MRI typically reveals injury in the basal ganglia, thalamus, or watershed zones—areas that are especially vulnerable to oxygen deprivation. This level of injury often necessitates more intensive medical management and a longer hospital stay.

Short‑term outcomes:

• Neonatal seizures occur in 30‑40% of moderate cases, often requiring antiepileptic medication.
• Hospitalization averages 7–10 days, with the need for respiratory support in about 40% of infants.
• Feeding difficulties may persist, necessitating tube feeding for a week or more.

Long‑term prognosis is more variable. Large cohort studies from ACOG and the NICHD (National Institute of Child Health and Human Development) indicate that 60‑80% of children with moderate HIE develop some form of neurodevelopmental impairment, ranging from mild cerebral palsy to moderate cognitive delays. Early intervention can substantially improve functional outcomes, and many children achieve independence in daily activities with appropriate support. The type and extent of impairment are highly individual, making personalized therapy plans crucial.

Factors that influence the moderate HIE trajectory include:

1. Therapeutic hypothermia: When started within six hours of birth, cooling reduces the risk of death or severe disability by about 25% (based on the NICHD Neonatal Research Network trial).
2. Seizure control: Prompt treatment of seizures is linked to better cognitive outcomes.
3. Neuroimaging patterns: Injury limited to the watershed zones carries a better prognosis than deep gray‑matter involvement.
4. Family‑centered rehabilitation: Early physical, occupational, and speech therapy correlate with higher scores on developmental assessments at two years.

Even beyond the first two years, children with moderate HIE often continue to benefit from school‑based support, adaptive technology, and periodic neuropsychological testing that can guide individualized education plans (IEPs). The commitment to ongoing therapy and support from families plays a significant role in maximizing developmental potential.

Prognosis for severe HIE

Severe HIE (stage 3) is the most concerning category. Babies are usually comatose, have flaccid muscle tone, and often experience frequent seizures. MRI frequently shows extensive damage to the basal ganglia, thalami, and cerebral cortex, indicating widespread brain injury. The immediate focus for these infants is often on stabilizing vital functions and preventing further damage.

Short‑term outcomes are sobering:

• Up to 80% of infants require mechanical ventilation for more than a week.
• Approximately 70% develop refractory seizures that may need multiple antiepileptic drugs.
• Multi‑organ dysfunction (e.g., renal or hepatic failure) can accompany severe brain injury.

Survival rates vary by region and by the availability of advanced neonatal care. In high‑resource settings, recent data from the ACOG Practice Bulletin (2022) suggest that around 30% of infants with severe HIE survive to hospital discharge. Of those survivors, 70‑80% have profound neurodevelopmental impairment, including severe cerebral palsy (GMFCS level IV‑V), profound cognitive delay, and epilepsy. For families facing this prognosis, discussions often include palliative care options to ensure comfort and dignity for their child.

Long‑term outcomes are heavily dependent on the extent of injury and the effectiveness of early interventions. Children who survive severe HIE often require lifelong support, including:

1. Complex medical care (e.g., feeding tubes, tracheostomy).
2. Intensive physical and occupational therapy to manage spasticity and positioning.
3. Speech and language therapy for communication challenges.
4. Special education services and adaptive technologies.

Even with the best possible care, the prognosis for severe HIE remains guarded, and families should be prepared for a range of possible outcomes, from limited interaction to full dependence. Comprehensive, coordinated care from a team of specialists is essential to support these children and their families.

Understanding the HIE Diagnosis: What Happens Next?

Receiving an HIE diagnosis for your newborn is a profoundly distressing experience, often unfolding rapidly in the intense environment of the NICU. After the initial diagnosis, your medical team will typically move quickly to confirm the severity and initiate appropriate interventions. This usually involves continuous monitoring of brain activity (aEEG), blood tests, and discussions about therapeutic hypothermia if your baby meets the criteria.

During this critical period, it’s normal to feel overwhelmed. Don't hesitate to ask your care team to explain everything in plain language, and to repeat information as many times as you need. Key questions to ask include: "What is my baby's Sarnat stage?", "Is therapeutic hypothermia an option, and what does it involve?", and "What are the next steps in our care plan?" Remember, you are your child's most important advocate, and understanding the immediate path forward can help you feel more in control during a very uncertain time.

Immediate interventions: therapeutic hypothermia

Therapeutic hypothermia—cooling the baby’s body temperature to 33.5 °C (92.3 °F) for 72 hours—is the only evidence‑based treatment that has been shown to improve outcomes across moderate and severe HIE. The cooling must begin within six hours of birth, ideally as soon as the diagnosis is confirmed. This narrow window is crucial because the secondary phase of brain injury, which cooling aims to mitigate, begins shortly after the initial oxygen deprivation.

How it works:

• Cooling slows the metabolic cascade that follows oxygen loss, reducing excitotoxicity and inflammation.
• It preserves the integrity of the blood‑brain barrier, limiting secondary injury.
• After rewarming, infants are closely monitored for seizures, electrolyte shifts, and cardiac rhythm changes.

Clinical trials, including the landmark NICHD Neonatal Research Network study, demonstrated a relative risk reduction of death or severe disability of 24% in infants who received hypothermia compared with standard care. Both the American College of Obstetricians and Gynecologists (ACOG) and the UK’s NICE guideline NG54 endorse therapeutic hypothermia for infants ≥36 weeks’ gestation with moderate or severe HIE. Contraindications for cooling include severe congenital anomalies, major intracranial hemorrhage, or an unstable cardiorespiratory status that would make cooling unsafe.

Potential side effects are generally manageable and include transient bradycardia, mild thrombocytopenia, and electrolyte disturbances. Centers that specialize in neonatal intensive care (NICU) have dedicated cooling devices and protocols to mitigate these risks. Families will be supported throughout the 72-hour cooling period and the subsequent gradual rewarming process, which typically takes another 6-12 hours.

Researchers are also exploring adjuncts to cooling, such as erythropoietin, xenon gas, and stem‑cell therapies. As of 2024, these approaches remain experimental and are only available within clinical trials approved by the FDA and the European Medicines Agency.

Long‑term management and rehabilitation

Regardless of initial severity, many infants with HIE benefit from ongoing therapy that targets motor, cognitive, and communicative development. Early, multidisciplinary rehabilitation can maximize neuroplasticity—the brain’s ability to reorganize and form new connections. This intensive phase of therapy often begins even before discharge from the NICU and continues for months to years, adapting as your child grows.

Key components include:

Physical therapy (PT)

PT focuses on muscle tone, strength, and gross motor milestones (rolling, sitting, walking). For moderate and severe HIE, therapists may use positioning devices, gentle stretching, and functional activities to prevent contractures. They might also introduce adaptive equipment to support movement and mobility.

Occupational therapy (OT)

OT addresses fine motor skills, sensory processing, and daily living activities. Therapists often incorporate play‑based interventions to encourage reaching, grasping, and hand‑eye coordination. This can include strategies for feeding, dressing, and developing independence in age-appropriate tasks.

Speech and language therapy (SLT)

Even infants without obvious speech delays can benefit from SLT to support feeding, oral motor skills, and later language development. Early intervention is linked to higher expressive language scores at age 3. For children with more severe HIE, SLT can also explore alternative and augmentative communication (AAC) devices.

Neurodevelopmental follow‑up

Most hospitals schedule regular assessments using standardized tools such as the Bayley Scales of Infant Development or the Ages and Stages Questionnaire. These evaluations help track progress and adjust therapy plans. A pediatric neurologist will typically oversee this long-term follow-up, coordinating care with other specialists.

Family‑centered care is essential. Parents are taught positioning techniques, home exercises, and signs of worsening tone or seizures. Peer support groups and counseling can also alleviate the emotional toll of caring for a child with HIE. Integrating therapy into daily routines at home significantly enhances its effectiveness.

Navigating the Educational System and Ongoing Support

As your child with HIE grows, their needs will evolve, and navigating the educational system becomes a crucial part of their long-term support. Early intervention services typically transition to school-based programs around age three, offering a range of resources tailored to individual learning and developmental needs. This transition can feel daunting, but knowing what to expect can empower you to advocate effectively.

Key aspects of educational and ongoing support include:

• Individualized Education Programs (IEPs): These legally binding documents outline specific educational goals, services, and accommodations for children with disabilities in public schools. Your child's team may include special education teachers, therapists, and school psychologists.
• Adaptive Technologies: Many children with HIE benefit from assistive devices, such as communication boards, specialized computer interfaces, or mobility aids, both at home and in school. Your therapy team can help identify and secure these tools.
• Specialized School Environments: Depending on the severity of impairment, some children may thrive in integrated classrooms with support, while others may benefit from more specialized educational settings designed for children with complex needs.
• Ongoing Therapies: While some therapies may transition to school-based services, many families continue with private physical, occupational, and speech therapy to supplement school offerings and address specific goals.

Building a strong support network with educators, therapists, and other parents of children with HIE is invaluable. Regular communication and active participation in your child's educational planning ensure that their unique strengths are recognized and their challenges are met with appropriate resources.

Monitoring and diagnostic tools

Accurate diagnosis and ongoing monitoring guide every treatment decision. Within the first hour of life, clinicians often obtain a cord blood gas to assess acidosis—a pH < 7.0 or base excess > ‑12 mmol/L raises suspicion for HIE. Continuous amplitude‑integrated EEG (aEEG) is now standard in many NICUs because it can detect subclinical seizures that a bedside exam might miss. These initial tests help determine the urgency and eligibility for therapeutic hypothermia.

Brain MRI performed between days 3‑5 is the gold‑standard imaging modality. Diffusion‑weighted imaging (DWI) highlights areas of restricted water movement, which correlate with the severity of injury. Serial MRIs can track the evolution of lesions and help predict long‑term outcomes. For some infants, cranial ultrasound may be used for initial screening or to monitor for complications like intraventricular hemorrhage, though MRI provides far greater detail for HIE assessment.

Emerging biomarkers such as serum S100B, neuron‑specific enolase (NSE), and lactate are being investigated as adjuncts to imaging, but they have not yet been incorporated into routine guidelines by ACOG or NICE. When available, these tests may provide additional reassurance or prompt earlier intervention. The combination of clinical assessment, physiological monitoring, and advanced imaging provides the most comprehensive picture of your baby's brain health and prognosis.

Potential complications and associated conditions

Beyond the primary brain injury, infants with HIE may develop a range of secondary complications, some of which differ by severity:

• Seizures: Occur in up to 40% of moderate and 70% of severe cases. Uncontrolled seizures can worsen brain injury and require prompt antiepileptic medication management.
• Feeding difficulties: Dysphagia and poor suck‑swallow coordination are common, sometimes requiring gastrostomy tubes. Speech therapists and dietitians are crucial in managing these challenges.
• Respiratory problems: Chronic lung disease or persistent apnea may develop, especially after prolonged ventilation. Close monitoring and respiratory support may be necessary.
• Growth restriction: Poor weight gain can result from metabolic demands and feeding challenges. Nutritional support and careful growth monitoring are essential.
• Visual and auditory deficits: Optic nerve injury or sensorineural hearing loss may emerge, warranting early screening. Regular ophthalmology and audiology assessments are recommended.
• Epilepsy: Long‑term seizure disorders affect up to 30% of moderate and 60% of severe survivors, often requiring ongoing medication and neurological follow-up.
• Endocrine issues: Hypothyroidism and growth‑hormone deficiencies have been reported in children with severe HIE. Regular endocrine screening can identify and address these.
• Orthopedic problems: Hip dysplasia and scoliosis can arise from chronic spasticity in severe cases. Physical therapy and orthopedic consultations are important for management.

Regular screening for these issues is part of the standard follow‑up schedule recommended by the American Academy of Pediatrics and the UK’s NHS Neonatal Network. Early detection allows timely intervention, which can mitigate the impact on overall development and improve your child's quality of life.

Support resources for families

Finding community and professional support can make a huge difference. Here are some reputable organizations that offer information, counseling, and connection to other families:

• HIE Foundation – Provides education, research updates, and a network of families navigating HIE. They offer a comprehensive website with personal stories, expert interviews, and advocacy tools.
• March of Dimes – Offers resources on newborn health, NICU experiences, and developmental follow‑up. Their mission focuses on improving the health of mothers and babies, including those facing complex medical challenges.
• American Academy of Pediatrics (AAP) – Neonatal Section – Publishes guidelines and patient‑friendly handouts. This is a great source for evidence-based information and best practices in neonatal care.
• National Health Service (NHS) – Neonatal Services – Lists local specialist centers in the UK. The NHS provides comprehensive care pathways and support for families of infants with HIE.
• Family Support Groups – Many hospitals host peer‑support meetings; ask your NICU social worker for details. Connecting with other parents who understand your journey can provide invaluable emotional support and practical advice.

Online forums such as “HIE Parents Connect” and “NICU Support Network” also provide a safe space to share experiences, ask questions, and learn from families who have walked a similar path. Additionally, many non‑profit agencies offer financial counseling, insurance navigation, and assistance with transportation to therapy appointments, helping to ease the practical burdens on families.

From our medical team: The first few weeks after an HIE diagnosis are often the most intense, but remember that early, evidence‑based interventions—especially therapeutic hypothermia for moderate to severe cases—have changed the outlook for many infants. Stay engaged with your care team, ask about neuroimaging results, and don’t hesitate to request referrals to physical, occupational, and speech therapists. Consistent, family‑centered therapy can help your child reach their fullest potential, regardless of the initial severity. We've seen firsthand the resilience of these children and the profound impact of dedicated care.

Myth vs. fact

Myth: All babies with HIE will have lifelong disabilities.

Fact: While the risk of neurodevelopmental impairment increases with severity, many infants—especially those with mild HIE—grow up with typical cognitive and motor abilities. Early therapy and therapeutic hypothermia have markedly improved outcomes.

Myth: Therapeutic hypothermia is risky and should be avoided.

Fact: When administered in a NICU setting within six hours of birth, cooling is safe and reduces death or severe disability by roughly one‑quarter. Side effects are usually mild and manageable, and the benefits far outweigh the risks for eligible infants.

Myth: If a baby shows no seizures, the brain injury must be minor.

Fact: Seizures are a common marker but not the sole indicator of injury severity. MRI findings and continuous aEEG monitoring, along with the clinical exam, together determine the true extent of brain damage. Some severe injuries may not present with obvious seizures.

Key takeaways

• HIE is classified as mild, moderate, or severe; each stage has distinct short‑ and long‑term outcomes.
• Mild HIE usually resolves with normal development; moderate HIE carries a 60‑80% chance of some impairment; severe HIE has a 20‑30% survival rate with high risk of severe disability.
• Therapeutic hypothermia, started within six hours, is the only proven acute treatment for moderate and severe HIE.
• Comprehensive rehabilitation—physical, occupational, and speech therapy—can improve function at any stage.
• Navigating the educational system with an IEP and considering adaptive technologies are key for long-term support.
• Watch for red‑flag signs such as worsening lethargy, new seizures, feeding intolerance, or abnormal breathing.
• Connect with support organizations like the HIE Foundation and your hospital’s NICU social worker for community and counseling resources.

Frequently asked questions

What is the life expectancy of a baby with severe HIE?

Most infants with severe HIE who survive the neonatal period live into adulthood, but many require lifelong medical support. Survival rates in high‑resource settings are around 30%, and a majority of survivors have significant neurodevelopmental impairment. Life expectancy is highly variable and depends on the specific complications and overall health.

Can a baby fully recover from HIE?

Full recovery is most common after mild HIE; moderate and severe cases often result in some degree of lasting impairment despite treatment. Early therapeutic hypothermia and intensive rehabilitation improve the odds of better functional outcomes, but complete recovery without any lasting effects is less common in more severe cases.

What are the signs of HIE getting worse?

Worsening lethargy, new or increasing seizure activity, poor feeding, unexplained apnea, or a decline in muscle tone should prompt immediate evaluation by your neonatology team. Any sudden, unexplained change in your baby's behavior or vital signs warrants urgent medical attention.

What treatments are available for HIE in newborns?

The cornerstone of acute care is therapeutic hypothermia for eligible infants, combined with supportive measures (maintaining oxygenation, glucose, and blood pressure). Antiepileptic drugs manage seizures, and multidisciplinary rehabilitation supports long‑term development. Experimental treatments are currently only available through clinical trials.

How does HIE affect a child's development?

Developmental impact varies with severity: mild HIE often results in normal milestones; moderate HIE can lead to mild to moderate cerebral palsy, learning difficulties, or speech delays; severe HIE frequently causes profound cerebral palsy, severe cognitive deficits, and epilepsy. The specific areas of the brain affected determine the type of developmental challenges.

Is mild HIE always curable?

Most children with mild HIE recover without lasting deficits, but a small percentage may develop subtle language or attention challenges that become apparent later in childhood. Ongoing monitoring ensures early detection and intervention, which can help manage these potential long-term effects.

Can therapeutic hypothermia be used for preterm infants?

Current guidelines from ACOG and NICE recommend cooling only for infants ≥36 weeks’ gestation because the safety profile in younger preterms is not yet established. Clinical trials are ongoing to determine if modified protocols could benefit late‑preterm babies, but for now, it's reserved for full-term or near-term infants.

What is the role of early intervention services after discharge?

Early intervention (EI) programs provide free, home‑based therapy for infants up to three years old. They coordinate PT, OT, and SLT services, monitor developmental progress, and help families set realistic goals. Participation in EI has been linked to higher functional scores and reduced need for special education later on.

What is the risk of HIE in future pregnancies?

For most parents, the risk of HIE in a subsequent pregnancy is low, especially if the cause of HIE in the first child was an acute, unpreventable event (like a cord prolapse). However, if there was an underlying maternal or placental condition, your obstetrician may recommend closer monitoring or specific interventions in future pregnancies to mitigate risks. Discuss your specific situation with your doctor.

Are there legal considerations for families affected by HIE?

While this article focuses on medical aspects, some families explore legal options if they believe medical negligence contributed to their child's HIE. It's a complex area, and seeking advice from a legal professional specializing in birth injury cases can help you understand your rights and options. This is separate from medical care, which should always be prioritized.

When to call your doctor

If you notice any of the following, contact your pediatrician or neonatology team right away: new or worsening seizures, persistent lethargy, feeding intolerance, unexplained breathing pauses, fever, or a sudden change in muscle tone. This information is for educational purposes only and does not replace personalized medical advice.

References

1. American College of Obstetricians and Gynecologists (ACOG). “Practice Bulletin: Neonatal Encephalopathy.” 2022.
2. American Academy of Pediatrics (AAP). “Guidelines for Neonatal Resuscitation and Therapeutic Hypothermia.” 2021.
3. National Institute of Child Health and Human Development (NICHD). “Therapeutic Hypothermia for Neonatal Encephalopathy.” New England Journal of Medicine, 2005.
4. National Institute for Health and Care Excellence (NICE). “Therapeutic hypothermia for hypoxic‑ischemic encephalopathy in newborns.” NG54, 2020.
5. World Health Organization (WHO). “Neonatal encephalopathy: guidelines for diagnosis and management.” 2021.
6. March of Dimes. “Understanding Hypoxic‑Ischemic Encephalopathy.” 2023.
7. HIE Foundation. “Resources for Families.” 2024.
8. British National Health Service (NHS). “Neonatal Encephalopathy.” Clinical Handbook, 2022.
9. Gunn AJ, et al. “Long‑term outcomes after therapeutic hypothermia for neonatal HIE.” Pediatric Research, 2019.
10. Shankaran S, et al. “Neurodevelopmental outcomes of infants with HIE treated with cooling.” JAMA, 2017.
11. American Academy of Pediatrics (AAP). “Neonatal Seizure Management.” 2020.
12. National Institute for Health and Care Excellence (NICE). “Early intervention services for children with neurodevelopmental disorders.” 2021.
13. Sarnat HB, Sarnat MS. “Neonatal encephalopathy following fetal distress. A clinical and electroencephalographic study.” Archives of Neurology, 1976.