Background Cooling may not be appropriate and further treatment is likely to be futile in babies who appear moribund or have persisting extremely severe encephalopathy and severely abnormal aEEG changes (CFM) beyond 12–24 h of age. (www.npeu.ox.ac.uk/tobyregister/Register-Clinicans-Handbook)

Aims To assess whether severely abnormal CFM changes in babies receiving therapeutic hypothermia were clearly documented and to ascertain whether treatment-limiting decisions were discussed with parents at 24 h of age.

Methods A retrospective review of case notes of babies who received therapeutic hypothermia at a tertiary NICU between October2007-December2013.

Results 89 patients were included in our final analysis.

31/89(35%) patients had abnormal CFM changes at 24 h. Of these 16/31(52%) had severely abnormal CFM changes. Withdrawal of care was discussed with parents in 10/16(62.5%) of babies with severe CFM changes at 24 h of age.

Of these 10 cases with severely abnormal CFM, 1 baby had care withdrawn due to multiorgan failure before 24 h. In 8 /16 (50%) cases, care was subsequently withdrawn after 24 h.

In 6/16(37.5%) of cases with severely abnormal CFM cooling was continued. However, 1 of these 6 cases later had a Do Not Resuscitate (DNR) placed on day 5.

Conclusions Severely abnormal CFM findings between 12–24 h of age must always be discussed with parents and where appropriate parents must be counselled regarding the likely futile nature of continuing intensive care.