What it is
The Thompson score grades the clinical severity of hypoxic-ischaemic encephalopathy (HIE) in term neonates using nine purely bedside signs — no EEG or imaging required. It was developed to predict neurodevelopmental outcome and is valuable where amplitude-integrated EEG is unavailable or while you are deciding on and monitoring therapeutic hypothermia. The peak score over the first days of life carries the prognostic weight.
The nine signs
Most signs score 0–2; tone, level of consciousness, posture, and respiration extend to 3, giving a maximum of 22:
- Tone: normal (0) · hyper (1) · hypo (2) · flaccid (3)
- Level of consciousness: normal (0) · hyperalert/stare (1) · lethargic (2) · comatose (3)
- Seizures: none (0) · <3/day (1) · >2/day (2)
- Posture: normal (0) · fisting/cycling (1) · strong distal flexion (2) · decerebrate (3)
- Moro: normal (0) · partial (1) · absent (2)
- Grasp: normal (0) · poor (1) · absent (2)
- Suck: normal (0) · poor (1) · absent ± bites (2)
- Respiration: normal (0) · hyperventilation (1) · brief apnoea (2) · apnoea needing IPPV (3)
- Fontanelle: normal (0) · full, not tense (1) · tense (2)
Doctaverse bands the total as:
- 0 — Normal
- 1–10 — Mild
- 11–14 — Moderate
- 15–22 — Severe
When to use it
- Term/near-term neonate with suspected perinatal asphyxia, to grade encephalopathy severity.
- Serial scoring across the first days — the peak score predicts neurodevelopmental outcome, and a peak ≥15 is associated with markedly worse prognosis.
- Alongside (not instead of) the cooling-eligibility criteria and aEEG when available.
Worked example
A term infant: hypotonia (2), lethargic (2), <3 seizures/day (1), fisting/cycling (1), partial Moro (1), poor grasp (1), poor suck (1), brief apnoea (2), full-but-not-tense fontanelle (1).
Total = 2 + 2 + 1 + 1 + 1 + 1 + 1 + 2 + 1 = 12/22 → Moderate. Continue serial scoring; a rise into the severe band changes the prognostic conversation and the urgency of neuroprotective care.
Pitfalls
- Peak, not first. A single early score under-grades an evolving injury — encephalopathy deepens over 24–72 h, so keep scoring serially.
- Sedation and paralysis confound it. Anticonvulsants, opioids, and especially cooling itself blunt tone, consciousness, and reflexes — interpret scores obtained during these treatments with caution.
- Not a cooling gate. Eligibility for therapeutic hypothermia uses its own physiological and exam criteria; the Thompson score grades severity and prognosis, it does not by itself decide treatment.
- It is validated in term neonates with suspected HIE and is not a substitute for a full neurological assessment.
Run it: Thompson Score (Neonatal HIE)
Decision support for qualified clinicians only — verify against current primary guidelines and your clinical judgement.