 The HELIX trial is carefully designed to be generalizable to all under-resourced neonatal units with sub optimal neonatal intensive in India and other low and middle-income countries, that bear a very high neonatal encephalopathy burden. However, the neonatal units need to have a good quality basic neonatal care, including facilities of neonatal resuscitation, administration of intravenous fluids, drugs and basic respiratory support, but not optimal cardio respiratory or 1:1 nursing care facilities. The HELIX trial will be conducted in the real life situation of under resourced public sector neonatal units lacking optimal tertiary intensive care in India. Exclusively clinical criteria will be used for case identification and recruitment, and no laboratory parameters, neuroimaging or cerebral function monitoring will be required for eligibility. The entire cooling therapy will be provided by the existing clinical teams, and the research team will only be involved in accurate and high quality data collection, so that the trial results are reflective of the routine clinical scenario. Clearly, the population co-morbidities and resources in Indian neonatal units are different to African and other low-income country neonatal units. If the HELIX trial results suggest that cooling is safe and effective in Indian neonatal units, the next stage would be to evaluate cooling therapy in under resourced neonatal units in Africa, and other low-income countries. 