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Predictive value of the Thompson score for short-term adverse outcomes in neonatal encephalopathy



To explore the predictive value of the Thompson score during the first 4 days of life for estimating short-term adverse outcomes in neonatal encephalopathy.


This observational study evaluated infants with neonatal encephalopathy (≥36 weeks of gestation) registered in a multicenter cohort of cooled infants in Japan. The Thompson score was evaluated at 0–24, 24–48, 48–72, and 72–90 h of age. Adverse outcomes included death, survival with respiratory impairment (requiring tracheostomy), or survival with feeding impairment (requiring gavage feeding) at discharge.


Of the 632 infants, 21 (3.3%) died, 59 (9.3%) survived with respiratory impairment, and 113 (17.9%) survived with feeding impairment. The Thompson score throughout the first 4 days accurately predicted death, respiratory impairment, or feeding impairment. The 72–90 h score showed the highest accuracy. A cutoff of ≥15 had a sensitivity of 0.85 and specificity of 0.92 for death or respiratory impairment, while a cutoff of ≥14 had a sensitivity of 0.71 and a specificity of 0.92 for death, respiratory or feeding impairment.


A high Thompson score during the first 4 days of life, especially at 72–90 h could thus be useful for estimating the need for prolonged life support.


  • The Thompson score on days 1–4 of age was useful in predicting death and respiratory or feeding impairments. The 72–90 h Thompson score showed the highest predictive capability.

  • Owing to the rarity of withdrawal of life-sustaining treatment in Japan, 43% of infants with persistent severe encephalopathy with a Thompson score of ≥15 at 72–90 h of age could regain spontaneous breathing, be extubated, and survive without tracheostomy. Meanwhile, approximately 50% of infants who survived without tracheostomy required gavage feeding.

  • Our results could provide useful information for clinical decision making regarding infants with persistent severe encephalopathy.

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Fig. 1: Patient inclusion flowchart.
Fig. 2

Data availability

The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.


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The authors are grateful to the staff of participating centers for their contribution to the data collection, and the infants and their parents for sharing the clinical information.


The study was supported by the Japan Society for the Promotion of Science KAKENHI (Grant Number JP20K08247).

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Authors and Affiliations




H.A., J.S., K.T., M.N., and O.I. designed the study and the survey items. All authors participated in the data collection. H.A. and K.Y. performed the statistical analyses. H.A., J.S., K.T., Akihito Takeuchi, Y.S., Tetsuya Isayama, and O.I. contributed to the interpretation of the findings. H.A., J.S., K.T., K.Y., and O.I. drafted the manuscript. All authors critically reviewed and revised the manuscript and approved the final published version. All authors agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Jun Shibasaki.

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The authors declare no competing interests.

Ethics approval and consent to participate

This study was approved by the Ethics Committees of the Kurume University School of Medicine and Saitama Medical University, Japan, and was conducted in compliance with the principles of the Declaration of Helsinki. The need for parental consent was waived because no identifying information was collected.

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Aoki, H., Shibasaki, J., Tsuda, K. et al. Predictive value of the Thompson score for short-term adverse outcomes in neonatal encephalopathy. Pediatr Res 93, 1057–1063 (2023).

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