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A term baby was born by vacuum-assisted delivery complicated by severe shoulder dystocia and a tight nuchal cord associated with foetal decelerations, leading to perinatal asphyxia. Passive cooling was initiated; resultant hypotension was supported by fluids and inotropes, and the child developed disseminated intravascular coagulation (DIC). Despite rewarming and ongoing supportive care, he continued to have significant haemorrhage secondary to DIC, including gastrointestinal bleeds and haematuria, and severe necrotic gastric perforation secondary to hypoxic injury. The baby underwent emergency laparotomy on day of life 2. Massive transfusion (MT) was provided according to the physician’s discretion throughout the first 4 days of life, including 9 red cell, 5 platelet, 4 cryoprecipitate and 11 fresh frozen plasma (FFP) transfusions. Following surgery, the baby stabilised, and his DIC improved. He ultimately went on to make a full recovery.