Which symptom is indicative of severe encephalopathy in neonates?

Severe hypotonia is a significant indicator of severe encephalopathy in neonates. Hypotonia refers to decreased muscle tone, which can be a hallmark of neurological dysfunction. In encephalopathy, the brain's ability to function properly is compromised, and as a result, muscular control and tone are often affected. In neonates with severe encephalopathy, the severe hypotonia may present as a “floppy” appearance, where the infant has difficulty maintaining posture or resisting passive movement due to diminished muscle tone. This can significantly impact the neonatal assessment and may suggest underlying neurological injury or maldevelopment.

The presence of increased deep tendon reflexes typically suggests the opposite, a state of hyperreflexia often associated with upper motor neuron lesions. Normal EEG readings would indicate that there are no significant electrical abnormalities in the brain, which would be inconsistent with severe encephalopathy. Lastly, hyperresponsiveness to stimulation can also be indicative of certain neurological conditions but is not solely a sign of severe encephalopathy; rather, it may represent a different type of brain dysfunction. Thus, severe hypotonia is the most direct and relevant symptom when assessing the severity of encephalopathy in neonates.