OBJECTIVE: To determine whether therapeutic hypothermia after hypoxic-ischemic encephalopathy in neonates improves survival and neurological outcome at 4 to 7 years of age. DESIGN: A meta-analysis was performed using a fixed effect model. Risk ratios, risk difference, and number needed to treat, plus 95% confidence intervals, were measured. DATA SOURCES: Studies were identified from the Cochrane central register of controlled trials, PubMed, EMbase, CINAHL, and conference proceedings. The period of bibliographic search was until June 2017. No language restrictions were applied. METHODS: Reports that compared whole body cooling or selective head cooling with normal care in neonates with hypoxic-ischemic encephalopathy and that included data on death or disability and on specific neurological outcomes of interest to patients and clinicians were selected. RESULTS: Among total 2,810 randomised controlled trial(RCT)s searched through the database, 46 were relevant after screening on bases of title and abstract. We found 7 RCTs, encompassing infants, that included information on death and major neurodevelopmental disability at 4 to 7 year-old follow-up. Therapeutic hypothermia significantly reduced the combined rate of death and severe disability in the trial with 4 to 7 years of age outcomes (risk ratio, 95% confidence interval to, P=; risk difference, 95% CI to), with a number needed to treat of (95% CI to). Hypothermia increased survival with normal neurological function (risk ratio, 95% CI to, P; risk difference, 95% CI to), with a number needed to treat of (95% CI to). Mortality was significantly reduced when we assessed all 46 trials (infants; relative risk, 95% CI to, P= ; risk difference, 95% CI to), with a number needed to treat of (95% CI to). CONCLUSIONS: In infants with hypoxic-ischaemic encephalopathy, therapeutic hypothermia is associated with a consistent reduction in death and better neurodevelopmental outcome at 4 to 7 years of age.