Regional variability in therapeutic hypothermia eligibility criteria for neonatal hypoxic-ischemic encephalopathy highlights differences in regional and national guidelines for treating infants with probable hypoxic-ischemic encephalopathy (HIE). Eligibility is typically based on evidence of perinatal hypoxia-ischemia and the presence of moderate or severe encephalopathy. Criteria for perinatal hypoxia-ischemia vary, including history of perinatal events, prolonged resuscitation, abnormal blood gases, and low Apgar scores. Encephalopathy severity is assessed using different neurological exams, with varying domains and interpretations. Early electrophysiological assessment is weighted differently across guidelines. These variations may lead to different care for infants based on birth location and affect epidemiological data. A universal severity staging of encephalopathy is advocated to standardize management and outcomes. Guidelines differ in gestational age, birth weight, and time of evaluation for eligibility. The role of aEEG in determining eligibility is also variable. Differences in criteria for seizures and encephalopathy severity may impact eligibility. The use of aEEG is encouraged in some guidelines but not universally available. Mild encephalopathy remains controversial, with no consensus on monitoring or management. Variability in guidelines may lead to different care and outcomes for infants. A standardized approach is needed to ensure consistent treatment and improve neonatal outcomes.Regional variability in therapeutic hypothermia eligibility criteria for neonatal hypoxic-ischemic encephalopathy highlights differences in regional and national guidelines for treating infants with probable hypoxic-ischemic encephalopathy (HIE). Eligibility is typically based on evidence of perinatal hypoxia-ischemia and the presence of moderate or severe encephalopathy. Criteria for perinatal hypoxia-ischemia vary, including history of perinatal events, prolonged resuscitation, abnormal blood gases, and low Apgar scores. Encephalopathy severity is assessed using different neurological exams, with varying domains and interpretations. Early electrophysiological assessment is weighted differently across guidelines. These variations may lead to different care for infants based on birth location and affect epidemiological data. A universal severity staging of encephalopathy is advocated to standardize management and outcomes. Guidelines differ in gestational age, birth weight, and time of evaluation for eligibility. The role of aEEG in determining eligibility is also variable. Differences in criteria for seizures and encephalopathy severity may impact eligibility. The use of aEEG is encouraged in some guidelines but not universally available. Mild encephalopathy remains controversial, with no consensus on monitoring or management. Variability in guidelines may lead to different care and outcomes for infants. A standardized approach is needed to ensure consistent treatment and improve neonatal outcomes.