Cooling for neonatal hypoxic-ischemic encephalopathy is a novel and promising neuroprotective therapy that requires significant understanding of how cooling affects all organ systems and interventions used to treat systemic complications of cooling in an intensive care setting. As cooling is used more widely and has been newly introduced in neonatal units, continued surveillance of its use in clinical practice is mandatory. Units offering cooling should strongly consider joining a registry (e.g. the Vermont-Oxford Neonatal Encephalopathy Registry in the USA or the TOBY Register in the UK) that facilitates benchmarking of short-term adverse effects and long-term outcomes of cooling and that supports local quality improvement efforts.
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