Objective <p>We assessed whether teleneonatology reduces time to goal temperature and early neurologic morbidity or mortality in outborn neonates with hypoxic-ischemic encephalopathy (HIE) that required therapeutic hypothermia (TH).</p> Study design <p>This retrospective observational study included outborn neonates with HIE treated with TH. The exposure was teleneonatology consultation. The primary outcome was time from birth to goal temperature (33–34 °C). The secondary outcome was a composite of early neurologic morbidity and in-hospital mortality.</p> Results <p>Of the 77 neonates included in the study, 42 (55%) received teleneonatology consultations. Teleneonatology reduced time to goal temperature (mean ratio 0.76 [95% CI, 0.58, 0.99]). This was partially mediated by earlier transport team activation and more frequent initiation of passive cooling prior to transport team arrival. There was no difference in early neurologic morbidity or mortality.</p> Conclusions <p>Teleneonatology reduced time to goal temperature in outborn neonates with HIE requiring TH by expediting key steps in care processes.</p>