Background & purposes:MR examination of infants with kernicterus shows abnormal changes in signal intensity in various parts of the brain, including the globus pallidus and subthalamic regions. The purpose of this study was to  see if the MR spectroscopic profiles of infants with hyperbilirubinemia and symptoms of kernicterus provide new insights into the pathophysiology of bilirubin and early diagnosis of bilirubin encephalopathy. Methods:This observational comparative study was done at Sayed Galal Univesity Hospital between June 2015 to December 2015. Eighteen newborns, with hyperbilirubinemia  were divided into 2 groups; Group one: newborns with neonatal Hyperbilinaemia  without encephalopathy (12 cases). Group two: newborns with neonatal Hyperbilinaemia and encephalopathy (NBE) diagnosed by BIND score (Bilirubin Induced Neurological Dysfunction Score) ( 6 cases). Brain MRI and MRS were done to both groups and the differences in imaging, clinical and biochemical data between both groups were evaluated statistically. Ethical committee approval and parent consent were obtained before the start of the study. Results: In our study, one case only in group II had abnormal increased signal intensity in the globus pallidus on T1-weighed MRI. However, we clearly demonstrated abnormal metabolism in MRS study with a decreased NAA/ Cr (N Acetyl Aspartate/ Creatine), and Cho/Cr (Choline/Creatine) ratios in the basal ganglia in the 6 neonates of group II. Conclusion and Recommendations: MRS is useful in the differential diagnosis of patients with NBE from patients with NH, especially when the symptoms of patients with NBE are subtle and MRI does not reveal clear obvious abnormalities.