Brain
Cooling eligibility checklist
Steps through the criteria for therapeutic hypothermia (cooling) for a baby with suspected hypoxic-ischaemic encephalopathy.
For education. Check against your unit's guidance and a second clinician before use.
A. Evidence of perinatal compromise
Gestation, plus at least one of the four.
B. Moderate or severe encephalopathy
Altered consciousness, plus at least one of the four.
Timing
Answer the three yes or no questions and tick what applies.
Before you use this
- Criteria are those used in the UK (from the TOBY trial); the NICHD and ICE trial criteria used elsewhere are similar. Check them against the current BAPM framework and your cooling centre's protocol.
- In low- and middle-income settings, the HELIX trial found cooling did not help and may cause harm: follow your national guidance.
How this is calculated
- Criteria A: born at 36 weeks or more, with at least one of: Apgar 5 or less at 10 minutes; continued resuscitation at 10 minutes; pH below 7.00 or base deficit 16 mmol/L or more within 60 minutes of birth.
- Criteria B: altered consciousness with at least one of: hypotonia, abnormal reflexes including oculomotor or pupil abnormalities, absent or weak suck, clinical seizures.
- Cooling should start within 6 hours of birth.
Sources
- BAPM. Therapeutic hypothermia for neonatal encephalopathy: a framework for practice.
- Azzopardi DV, Strohm B, Edwards AD, et al. Moderate hypothermia to treat perinatal asphyxial encephalopathy (TOBY). N Engl J Med 2009;361:1349-58.
- NICE. Therapeutic hypothermia with intracorporeal temperature monitoring for hypoxic perinatal brain injury (IPG347).
- Thayyil S, et al. Hypothermia for moderate or severe neonatal encephalopathy in low-income and middle-income countries (HELIX). Lancet Glob Health 2021;9:e1273-85.
Checked by NICUlearn, 6 Oct 2026.