Background: The prognostic value of early MRS in neonatal HIE has been reported by multiple groups. Despite reports of persistent elevation of lactate peak in neonatal HIE, the utility of MRS after the first week of life in this population remains to be determined. Materials and Methods: This is s retrospective chart review of neonates admitted to GUH for HIE who underwent total body cooling between Jan 2013 and March 2018. All included patients had follow-up Neurology and/or Neurodevelopmental (Bayley’s scale) evaluations every 6 months.  MRI (including DWI, ADC sequences) and MRS were obtained on a 1.5 or 3T Siemens scanner with region of interest in the left basal ganglia. Images were reviewed by two neuroradiologists blinded to patient’s clinical condition.  Outcome was determined based on neurologic evaluation and/or Bayley’s scores in the motor, sensory and cognitive/language domains. Relation between abnormalities on imaging and neurological outcome was determined. Results: We identified 27 neonates with MRS; 5 were excluded due to presence of additional abnormalities on MRI (IVH, ICH). Three patients were lost at follow-up; therefore, data analysis included 19 term neonates (13 males, 6 females). Imaging was obtained at DOL 5-22 (median, 7). Three patients had brain MRI compatible with HIE; all MRS were unremarkable. Following total body cooling for 72 hours two patients had mild language delay and two had severe delay. Three patients had mild motor delay. Conclusions: Our data suggest that in neonatal HIE MRS obtained after DOL 5 does not support prognostication of long-term developmental outcome.