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Objective  Therapeutic hypothermia (TH) is currently the only effective therapy available to improve outcomes in neonates with hypoxic-ischemic encephalopathy (HIE) and has maximal effect when initiated within 6 hours of birth. Neonates affected by HIE are commonly born outside of cooling centers and transport is a barrier to timely initiation. In this study, we sought to determine if the initiation of servo-controlled TH in transport allowed neonates to reach target temperature earlier, without a significant delay in the transfer process, for both local and long-distance transport. Study Design  In this single-center cohort study of neonates referred to a level IV neonatal intensive care unit for TH, we determined the chronologic age at which target temperature was reached for those cooled in transport. Short-term outcome measures were assessed, including survival, incidence of electrographic seizures, discharge feeding method, and length of hospitalization. Results  In a study population of 85 neonates, those receiving TH during transport (n  = 23), achieved target temperature (33–34°C) 77 minutes sooner (230 ± 71 vs. 307 ± 79 minutes of life (MOL); p  < 0.001). Locally transported neonates (<15 miles) achieved target temperature 69 minutes earlier (215 ± 48 vs. 284 ± 74 MOL; p  < 0.01). TH during long-distance transports allowed neonates to reach target temperature 81 minutes sooner (213 ± 85 vs. 294 ± 79 MOL; p  < 0.01). Infants who were cooled in transport discharged 4 days earlier (13.7 ± 8 vs. 17.8 ± 13 days; p  = 0.18) and showed a significantly higher rate of oral feeding at discharge (95 vs. 71%; p  = 0.03). Conclusion  For those starting TH in transport, time to target temperature was decreased. In our cohort, cooling in transport was associated with improved short-term outcomes, although additional studies are needed to correlate these findings with long-term outcomes. Key Points Therapeutic hypothermia started during transport allows shorter time to target temperature. Transfer was minimally delayed by starting cooling in transport. Cooling in transport was associated with increased rate of oral feeding at hospital discharge. [ABSTRACT FROM AUTHOR]