Perinatal asphyxia and resulting hypoxic ischemic encephalopathy (HIE) occur in 1 to 3 per 1000 births in the United States. Induced hypothermia as an intervention for asphyxiated infants offers promising results in reducing neurodevelopmental disabilities in surviving infants. Induced hypothermia and selective head cooling are effective interventions for asphyxiated infants that minimize continued neuronal damage and decrease neurodevelopmental disability at 18 months of age. Identification of affected infants immediately after delivery and transfer to a facility that provides this therapy is necessary to maximize the potential of this intervention. Standardization of hypothermia protocols within neonatal intensive care units is essential for providing hypothermia as a treatment of HIE in infants. This article explores the pathophysiology of HIE, identifying infants at risk for HIE as a result of perinatal asphyxia, the use of hypothermic intervention for compromised infants, and barriers to the implementation of treatment.