Thompson Score — Neonatal HIE
Bedside neonatal encephalopathy scoring across nine domains (0 to 27 total) to support early severity staging, serial trend tracking, and protocol-based escalation.
Last reviewed: February 26, 2026
Clinical disclaimer
Rapid bedside workflow
- Confirm birth timeline, resuscitation details, and current medication context.
- Score all nine Thompson domains and record both domain values and total.
- Assign provisional severity band and compare against local cooling pathway criteria.
- Document confounders (sedation, anticonvulsants, ventilation changes).
- Set the next reassessment time before leaving bedside.
How the Thompson score works
The score assigns 0 to 3 points across tone, level of consciousness, fits/seizures, posture, Moro reflex, grasp reflex, suck reflex, respiratory pattern, and fontanelle tension. Total range is 0 to 27.
Commonly used interpretation bands (verify locally): 0 to 10 mild, 11 to 14 moderate, and 15 or higher severe encephalopathy. Most teams prioritize serial trend over a single isolated score.
Interpretation and escalation cues
- Rising scores over sequential exams should trigger urgent pathway review.
- Moderate or severe patterns often require immediate neonatology escalation.
- Borderline scores are high-risk when neurologic trajectory is worsening.
- Use score trajectory with blood gases, perinatal events, and neurologic adjuncts.
Reassessment cadence
- During early evolution window: repeat structured scoring at short protocol intervals.
- After major treatment changes (cooling, anticonvulsants, ventilation): reassess once exam is interpretable.
- If neurologic or physiologic trajectory worsens: immediate reassessment and escalation.
Common failure modes
- Scoring after sedative or anticonvulsant exposure without documenting timing.
- Relying on one score instead of serial reassessment during evolution window.
- Missing seizure evolution between score checkpoints.
- Treating total score as prognosis without EEG/imaging context.
Immediate escalation triggers
- Rising serial scores or worsening neurologic trajectory over short intervals.
- Moderate/severe pattern with evolving cardiorespiratory instability.
- Diagnostic uncertainty where score and clinical trajectory diverge.
- Post-treatment changes (cooling/sedation) obscuring reliable exam interpretation.
Documentation checklist
- Exam timestamp relative to birth, resuscitation, and medication exposure.
- All domain values plus total score and interpretation band.
- Confounders affecting exam fidelity.
- Cooling pathway status and consult/escalation actions.
- Next reassessment time and responsible team.
Handoff template
- Current score with domain-level values and timestamp.
- Perinatal history context and treatment timeline (cooling, medications).
- Confounders affecting exam reliability.
- Trend direction versus previous score(s) and adjunct data (EEG/imaging/labs).
- Planned reassessment time and escalation trigger.
Clinical limits
- Limited validation in very preterm infants.
- Lower reliability during deep sedation, paralysis, or unstable cardiorespiratory support.
- Not a substitute for EEG, neuroimaging, or specialist neurologic exam.
Related tools
- AAP 2022 Bilirubin calculator and BIND / BIND-M for bilirubin encephalopathy context.
- Pediatric Vital Signs for physiologic trend interpretation.
References
FAQs
Use it early, usually within the first 6 to 24 hours after birth, then repeat serially as neurologic findings evolve during the first 72 hours.
Treat it as a dynamic risk signal rather than a final answer. Reassess quickly, document exam context, and integrate gases, perinatal events, and neurologic trajectory.
Yes. Sedation, anticonvulsants, and recent intubation can blunt tone, responsiveness, and seizure visibility. Always document timing of interventions before scoring.
Many pathways use moderate or severe Thompson patterns together with gestational-age, biochemical, and perinatal criteria. Follow local protocol and involve neonatology early.
No. Single scores are useful snapshots but should not replace serial exams, EEG background, MRI context, and broader clinical trajectory.
It is mainly used in term or near-term infants. In very preterm infants, interpret cautiously and defer to neonatal neurology guidance.
Many teams consider scores >=15 severe, but threshold use varies by protocol. Always apply local criteria and serial trend analysis.
Frequency varies by acuity. In early high-risk periods, reassessment every few hours is common until trajectory stabilizes.
Yes. Clinical deterioration overrides a stable numeric score; escalate based on overall neurologic and physiologic trajectory.