Background Neonatal encephalopathy, abnormal neurological function in a baby born at term is a key cause of neonatal death. In the absence of adequate training and brain imaging or monitoring in low-resource settings, clinical risk scores, such as Thompson score, have been useful to predict risk of neonatal encephalopathy. A clearer understanding of the clinical and maternal predictors of abnormal values of Thompson score would be beneficial to identify term neonates with suspected neonatal encephalopathy. Methods A scoping review of the literature identified a set of a priori neonatal and maternal variables associated with neonatal encephalopathy in low-resource settings. Next, a prospective study of all neonates born at term admitted to Sally Mugabe Central Hospital in Zimbabwe between October 2020 and December 2022 (n=6,054) was conducted. A predictive statistical model for abnormal (>10) Thompson score (range 0-22) was developed. Results In total 45 articles were identified from three databases and 10 articles were selected. 45 candidate predictors were identified - 36 from the available literature and 9 from clinical data and experience. 4.06% (n=246) of babies had an abnormal Thompson score of 10 or more on admission and 90.65% (n=223) of these neonates had an Apgar score less than 7 at 5 mins (p<0.001). 24 possible predictors were selected as the most important of which nine factors were identified as the most useful in predicting which neonates are at risk of abnormal Thompson score. These predictors and their adjusted odds ratios are: low Apgar score at 5min (OR= 0.46, 95%CI=(0.42, 0.51)), low neonatal heart rate at admission (OR=0.977, 95%CI=(0.97, 0.985)), temperature lower than 36.5°C (OR=1.64, 95%CI=(1.18, 2.28)), abnormal head shape (OR=2.12, 95%CI=(1.51, 2.97)), resuscitation received (OR=3.95, 95%CI=(1.69, 11.01)), neonatal encephalopathy as an admission reason (OR= 2.47, 95%CI=(1.37, 4.32)), risk factors of sepsis other than premature rupture of membrane and offensive liquor (OR=2.04, 95%CI=(1.1, 3.67)), respiratory distress as an admission reason (OR=2.48, 95%CI=(1.59, 3.96)), and other admission reasons (OR=1.81, 95% CI=(1.12, 2.97)). The main admission reasons in ‘Other’ category include low birthweight, meconium aspiration and hypoxic ischaemic encephalopathy and congenital abnormality. Conclusion In resource-poor settings where it may be not possible to clinically assess all admitted babies, those with these risk factors should be prioritised for a Thompson score assessment. Local clinical guidelines should incorporate these factors into the clinical management of at-risk neonates and assess their impact on clinical care and neonatal outcomes.

The authors have declared no competing interest.

The study was funded by the Wellcome Trust (215742/Z/19/Z). The funder played no role in the research design and delivery.

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This project is a sub-study of the wider Neotree project which has research ethical approval from the Harare Central Hospital Research Ethics Committee (Reference number HCHEC070618/58) and UCL Research Ethics Committee (UCL Research Ethics Committee (reference 5019/004) including the analysis carried out in this paper. This sub-study is registered with the UCL Great Ormond Street Institute of Child Health R&D Office (R&D number 20PP42).

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