Therapeutic hypothermia (TH) has been associated with improved outcomes in term infants who present with moderate hypoxic-ischaemic encephalopathy (HIE). However, in the three major studies the time to initiate cooling was at approximately 4.5 postnatal hours. Many newborns are referred to specialist centres where cooling takes place from outlying hospitals (‘outborn’). It may be the case that earlier initiation of TH could improve outcomes, leading Takenouchi and colleagues to propose a ‘Chain of Brain Preservation’.
‘Given that most infants are outborn, a time sensitive education metaphor termed Chain of Brain Preservation may facilitate early recognition of high risk infants and thus earlier treatment.‘

Chain of Brain Preservation—A concept to facilitate early identification and initiation of hypothermia to infants at high risk for brain injury
Resuscitation. 2010 Dec;81(12):1637-41