The three objectives of this study were to characterize the circumstances of death in asphyxiated newborns treated with hypothermia, to describe the approach for end-of-life decision-making in a tertiary-level neonatal intensive care unit (NICU) and to compare it to the available literature.

Despite significant advances in the management of neonatal encephalopathy secondary to birth asphyxia, mortality remains high among this population.

We conducted a retrospective cohort study of all asphyxiated newborns treated with hypothermia who died between 2008 and 2017 in a tertiary-level NICU. All the circumstances around neonatal death, including time of death, stability of newborns at the time of death, brain MRI results and brain autopsy results were collected.

Majority of deaths in asphyxiated newborns treated with hypothermia occurs within the first few days of life after elective extubation following discussion between parents and health care providers about guarded prognosis. Withdrawing nutrition and hydration was a more challenging option to contemplate in the newborns surviving the acute period with severe brain injury and palliative care or medical ethics were always involved to support parents and health care providers in their discussion and decisions.