Background: Neonatal encephalopathy (NE) contributes to worldwide perinatal mortality. Therapeutic hypothermia (TH) has turned moderate-to-severe NE into a perinatal emergency, however, identification of NE remains challenging. Our aim was to determine whether telemedicine could improve recognition of moderate-to-severe NE and neurologic outcome. Methods: Population-based, prospective cohort study of consecutive newborn infants with more than 35 weeks’ gestation experiencing perinatal asphyxia admitted at 12 hospitals in Spain between June 1, 2011 and June 1, 2013. Structured neurologic examinations to assess the severity of NE were performed and recorded at one, three, and five hours by the attending physician. The videos were blindly examined after the recruitment period by two experienced neonatologists. Outcome was assessed at 36 months of age using standardized tests. FindingsOf the 32,325 liveborn infants, 217 met the inclusion criteria (93 female [57%]). Video-recordings were available for 174 infants (80%). Weighted kappa statistic (κw) was 0·74 (95% confidence interval [CI], 0·67-0·81; P