Background: Hypoxic-ischemic encephalopathy (HIE) continues to be a leading cause of neonatal morbidity in India, especially in referral centers serving high-risk deliveries. Despite the adoption of neuroprotective strategies such as therapeutic hypothermia, long-term developmental outcomes in affected neonates remain variable. This study evaluated neurodevelopmental outcomes at one year of age among infants diagnosed with HIE in a tertiary neonatal unit. Methods: A prospective observational study was conducted from August 2024 to June 2025 in the Department of Pediatrics, Apollo institute of Medical Science & Research, Apollo Health City Campus, Film Nagar, Jubilee Hills, Hyderabad, Telangana, India. Sixty neonates with clinical and biochemical features consistent with HIE were enrolled. Sarnat staging was used for initial grading, and therapeutic hypothermia was offered to eligible neonates. Bayley-III developmental assessments were performed at one year of corrected age by trained examiners blinded to initial severity. MRI brain findings, NICU course, and clinical predictors of poor outcomes were recorded and analyzed. Results: Out of 60 neonates, 22 (36.7%) were classified as Sarnat Stage II and 10 (16.7%) as Stage III. Therapeutic hypothermia was administered to 40% of eligible neonates. At one-year follow-up, 18.3% demonstrated moderate to severe neurodevelopmental delay, primarily in the motor domain, while 61.7% had normal developmental scores. Poor outcomes were significantly associated with abnormal MRI (p=0.02), persistent seizures (p=0.01), and Stage III HIE (p<0.01). Conclusions: A substantial proportion of neonates with moderate to severe HIE are at risk of neurodevelopmental impairment at one year, with motor delays being most prominent. Early therapeutic hypothermia, coupled with structured developmental follow-up, offers the potential to improve long-term outcomes. Integration of post-discharge neurodevelopmental screening into routine neonatal care is essential in Indian public hospital settings.