Objective To characterize the implementation of hypothermia for neonatal hypoxic ischemic encephalopathy in a population-based cohort. Study design Using the California Perinatal Quality Care Collaborative and California Perinatal Transport System linked 2010–2012 datasets; infants >/= to 36 weeks gestation with hypoxic ischemic encephalopathy were categorized as receiving hypothermia or normothermia. Socio-demographic and clinical factors were compared and multivariable logistic regression was used to determine factors associated with hypothermia therapy. Results There were 238 reported encephalopathy cases in 2010, 280 in 2011 and 311 in 2012. Hypothermia therapy use in newborns with hypoxic ischemic encephalopathy increased from 59% to 73% across the study period, mainly occurring in newborns with mild or moderate encephalopathy. A total of 36 centers provided hypothermia and cared for 94% of infants, the remaining 6% being cared for at one of 25 other centers. Of the centers providing hypothermia, 12 centers performed hypothermia therapy to over 20 patients during the three-year study period, and 24 centers cared for < 20 patients receiving hypothermia. In-hospital mortality was 13%, primarily associated with the severity of encephalopathy. Conclusions Our findings highlight an opportunity to explore practice site variation and to develop quality improvement interventions to assure consistent evidence-based care of term infants with hypoxic ischemic encephalopathy and appropriate application of hypothermia therapy for eligible newborns.

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