The essential component to neonatal adaptation after birth is the initiation of adequate respiratory effort. Approximately 10–15% of newborns require support for respiratory transition at birth, 3% require positive pressure ventilation by mask, 2% intubation, and only <1% cardiopulmonary resuscitation with chest compressions or epinephrine to establish cardiorespiratory function [1,2]. The major cause for delivery room cardiopulmonary resuscitation is birth asphyxia, a condition of insufficient oxygen supply to vital organs that results in hypoxia, hypercarbia, and metabolic acidosis and, if prolonged, may progress to multiorgan failure, including the developing brain, which is then referred to as hypoxic ischemic encephalopathy [3, 4]. The neonatal modification of the SOFA (nSOFA) was proposed to address the need for a consensus definition of neonatal sepsis in 2020 [13]. nSOFA uses three objective and broadly available clinical parameters to quantify organ dysfunction: respiratory, cardiovascular, and hematological scores (total scores range from 0 to 15).  It was previously used for predicting mortality and severe morbidity in preterm infants [14], preterm infants with late onset sepsis [15], respiratory distress syndrome (RDS) [16], and neonates with proven sepsis [13,17]. Thus, the score was already shown to be predictive independent of the cause of organ dysfunction in the first 24 and 72 h.The aim of the present study was to evaluate the accuracy of the nSOFA for predicting in-hospital mortality (sensitivity, specificity) following moderate to severe hypoxic–ischemic encephalopathy