Objective To determine the usefulness of video recordings for validating neonatal encephalopathy (NE) exams.

Design Population-based prospective cohort study. NE was assessed and recorded at 1, 3 and 5 hours after birth by the attending physician. Recordings were reviewed blindly after the recruitment period by two specialists. Outcome was assessed at 36 months of age.

Setting Twelve intensive care units in Spain.

Patients Infants of ≥35 weeks’ gestational age with perinatal asphyxia.

Main outcomes measures Weighted kappa to measure disagreement between the two specialists and between the attending physician and the specialists’ classification agreed on by consensus. Regression models to test the association of disagreement on NE assessment and outcome.

Results Of the 32 325 liveborn infants, 217 met the inclusion criteria. Video-recordings were not available for 43 infants (20%). Weighted kappa statistic was 0.74 (95% CI 0.67 to 0.81) between the specialists and the attending physicians. Disagreement occurred in 93 of the 417 (22%) videos, specifically in 39 (14%), 43 (47%), 11 (34%) and 0 exams categorised as no, mild, moderate and severe NE, respectively. According to the specialist consensus assessment, there was disagreement on the therapeutic hypothermia decision in 10 infants.

When there was consensus among the specialists assessing a more severe NE degree compared with the attending physicians in 170 infants, those infants had lower cognitive scores with a median of −5.33 points (95% CI −9.85 to −8.16; p=0.02).

Conclusions This study supports the feasibility and benefit of using video recordings to identify NE in infants with perinatal asphyxia.