This tool is intended to promote identification and early referral of babies at risk for hypoxic ischemic encephalopathy (HIE). It does not determine if a baby should be cooled. The decision to proceed with cooling should only be made after consultation with a Regional Cooling Center (ref. CCS numbered letter), based upon their institutional criteria. These recommendations are based on the HIE early screening toolkit published by the California Perinatal Quality Care Collaborative (CPQCC)
Gestational Age >= 35wks *
Best estimate of gestational age in weeks
Yes No unknown
Age in Hours *
Hour of life to the nearest 0.1 hour
Acute Perinatal Events
Please select all that apply. This is a list of sentinel events known to significantly increase risk for HIE









Apgar @10min
Apgar score at 10 minutes of life, if available
Worst Cord Blood Gas
Worse of the arterial and venous cord blood gas, if available
Infant Blood Gas within 1hr of life
Infant gas within one hour of life, if available
CPR/Epinephrine
select measures for resuscitation
  • If directed to cool, see protocols: