Perinatal asphyxia means a disorder of the exchange of respiratory gases through the placenta during pregnancy and/or childbirth or in the lungs of a newborn immediately after birth with consequent hypoxemia, hypercapnia and metabolic acidosis. The incidence of perinatal asphyxia in developed countries is 2-6/1000 births but in underdeveloped countries it is ten times higher. Perinatal asphyxia can occur due to maternal chronic preconception diseases and conditions, complications of pregnancy with a consequence on placental function, complications of childbirth or due to diseases of a newborn which impair ability for cardiorespiratory adaptation to extrauterine life. Although perinatal asphyxia to a greater or lesser extent, damages all organs and systems, according to the risk of permanent neurological consequences, hypoxic-ischemic encephalopathy stands out as its most serious complication. Despite advances in the treatment of asphyxial brain damage since the introduction of therapeutic hypothermia into clinical practice, the most severe cases are still associated with a high risk of death or severe neurological damage in case of survival. Therefore, prevention of asphyxia through its timely recognition is still a prerequisite for a favorable treatment outcome.