German Hypothermia Registry Improves Clinician Confidence and Harmonises Decentralised Neonatal Hypoxic-Ischaemic Encephalopathy Care in Germany.

Aim: Decentralised implementation of therapeutic hypothermia (TH) for neonatal hypoxic-ischaemic encephalopathy (HIE) in Germany historically caused heterogeneous clinical practices. The aim of this study was to assess the impact of the German Hypothermia Registry on clinical standardisation and confidence in neonatal HIE care since its initiation in 2022.

Methods: We conducted a nationwide, two-phase, web-based survey in 2022 (n = 66) and 2025 (n = 222). A longitudinal subgroup analysis included physicians participating in both surveys (n = 30). Outcomes included guideline adherence, subjective diagnostic and therapeutic confidence, and perceived needs for further standardisation.

Results: From 2022 to 2025, clinician confidence improved across most domains. Complete confidence in diagnosing HIE increased from 42.4% to 80.0% in the longitudinal subgroup, while confidence in performing TH rose from 53.0% to 86.7%. Clarity regarding inclusion criteria reached 100% among longitudinal participants. In contrast, complete confidence in neurological assessment (36.7%) and amplitude-integrated electroencephalography (aEEG) interpretation (60.0%) remained comparatively lower in 2025.

Conclusion: The German Hypothermia Registry markedly improved standardisation and clinician confidence in neonatal HIE care. However, neurological assessment and aEEG interpretation remain key areas requiring targeted educational support.