A comatose neonate lays motionless with eyes totally or partially closed. This appearance resembles and must be differentiated from sleep, death, severe generalized hypotonia with facial involvement, and status epilepticus.

A comatose neonate may not be aroused regardless of the intensity of the stimuli, may require excessive stimuli to be aroused, or is unable to sustain a normal arousal response. Normal sleeping neonates have a normal arousal response.
A normal arousal response is characterized by eye opening, facial grimacing or crying, and limb movements. The intensity of the stimulus required to provoke an arousal and the duration of the arousal depends on gestational age and has a temporal relation to feeding.