Background: Hypoxic-ischaemic encephalopathy in adults and older children (i.e. not neonates), also known as global hypoxic-ischaemic injury, is seen in many settings and often has devastating neurological sequelae. Magnetic Resonance imaging—has the potential to play a significant role in diagnosis and early intervention in cases of HII. In addition, imaging studies performed in the subacute stages of injury provide information on the severity and extent of injury and can be helpful in predicting long-term outcome. Material and Methods: This prospective study was conducted in a Department of Radiology, Shadan Institute of Medical Sciences, Teaching Hospital & Research Centre, Hyderabad over a period of 1 year. A total of 70 patients with history of birth asphyxia were included in the study who underwent MRI of brain and were followed up clinically at the end of one year to assess the neurological outcome. Result: Of the 65 babies, 43 were males and 22 females, which correspond to 66.1% of male and the rest female babies. Maximum patients, i.e., 53.8% (n = 35) were having Apgar score of 4-6 followed by ≤3 score was 29.2% and least were > 7 score were 16.9%. In HIE 2 cases, 32.3% had involvement of corpus callosam. 24.6% had PVL, 16.9% had basal ganglia or thalamus lesion. There was no MRI evidence of HIE in 26.1% Conclusion: HIE is an important cause of morbidity and mortality in the neonatal period. MRI show characteristic pattern of brain injury and help to exclude other causes of encephalopathy. Imaging plays an important role in early diagnosis and timely intervention, thereby reducing the severity of neonatal brain injury.