This review article highlights the variability in eligibility criteria for therapeutic hypothermia (TH) in neonates with probable hypoxic-ischemic encephalopathy (HIE). The criteria for perinatal hypoxia-ischemia and moderate to severe encephalopathy vary across different regional and national guidelines, leading to differences in patient selection for TH. The role of early electrophysiological assessment, such as amplitude-integrated EEG (aEEG), is also weighted differently. These variations can result in infants receiving different care based on their location of birth and impact epidemiological data. The authors advocate for a universally endorsed single severity staging of encephalopathy to standardize management and neonatal outcomes. They also emphasize the importance of incorporating additional neurophysiological monitoring when available to supplement clinical assessment. The review concludes by discussing the challenges and implications of these variations, particularly in the context of mild encephalopathy, and calls for further research to address these issues.This review article highlights the variability in eligibility criteria for therapeutic hypothermia (TH) in neonates with probable hypoxic-ischemic encephalopathy (HIE). The criteria for perinatal hypoxia-ischemia and moderate to severe encephalopathy vary across different regional and national guidelines, leading to differences in patient selection for TH. The role of early electrophysiological assessment, such as amplitude-integrated EEG (aEEG), is also weighted differently. These variations can result in infants receiving different care based on their location of birth and impact epidemiological data. The authors advocate for a universally endorsed single severity staging of encephalopathy to standardize management and neonatal outcomes. They also emphasize the importance of incorporating additional neurophysiological monitoring when available to supplement clinical assessment. The review concludes by discussing the challenges and implications of these variations, particularly in the context of mild encephalopathy, and calls for further research to address these issues.