Hypoxic-ischemic encephalopathy (HIE) is a major cause of neonatal morbidity and mortality. To evaluate the diagnostic and prognostic utility of the Sarnat scale in grading HIE severity. A literature review of clinical studies, guidelines, and evidence-based sources was conducted. Strong correlations were found between Sarnat staging and EEG findings, MRI patterns, and long-term neurodevelopmental outcomes. Stages II–III reliably guide therapeutic hypothermia initiation. The Sarnat scale remains a practical and clinically valuable tool for early HIE assessment.