Aims Therapeutic hypothermia (TH) has become the standard of care for term newborns with hypoxic ischaemic encephalopathy (HIE). The major cooling trials had specific criteria to select infants with moderate-severe encephalopathyand the BAPM guidance recommends approaches compatible with those trials. Our objectives were:

1. To assess the completeness of neurological assessment documentation used for referring the infant for TH.

2. To compare the examination findings with published criteria for encephalopathy, as used by the two major cooling trials.

Methods Two cohorts of infants referred to the London Neonatal Transfer Service for TH between July 2011–June 2013 and July 2014–June 2015 respectively were included. Case records were reviewed.

Results Data were available on 266 infants transferred to the cooling centres, 145 in the first period and 121 in the second respectively. Baseline and clinical characteristics were comparable between the two groups. During the second period, active servocontrolled hypothermia in transport became the standard of care and a neurological assessment tool was introduced. Neurological assessment was documented by the referring hospital in 83/117 babies (70.9%), whereas the Neonatal Encephalopathy Assessment Sheet was completed by NTS in 64/116 babies (56.1%). Tone was the most common neurological feature assessed in both groups [97% vs 97.5%]. Assessment was sufficiently complete to allow the matching with TOBY and NICHHDcriteria only in 62/145 (42.7%) infants in the first period and 42/121 (34.7%) and 49/121 (40.4%) respectively in the second period. When measured against the TOBY encephalopathy assessment criteria, 31/62 (50%) infants in the first group and 20/42 (47.6%) fulfilled the criteria. When reviewed for encephalopathy assessment criteria as published by the Shankaran et al, 18/42 (42.8%) in the first group and 21/49 (42.9%) in the second group did meet the minimum three of the six categories required.

Conclusion The documentation of neurological assessment was not sufficiently complete in 40% referrals, in spite of a neurological examination assessment form. Also, the majority of the babies with complete documentation did not fulfil the criteria for encephalopathy according to published trials. There was no significant improvement over the years. This can have important clinical, resource and medico-legal implications.