Background: The use of serum amyloid A as a synergistic predictor of the level and extent of brain injury has been mentioned by many literatures yet no correlation between resistive index -as a reflector of cerebral blood flow velocity- cranial imaging and mortality outcomes have been detected. Objectives:This study aimed to evaluate serum amyloid A and cranial ultrasound (CUS) in hypoxic ischemic insult and assess its relation to consequences as mortality in neonates. Subjects and Methods: A prospective cohort study was done on 35 full term (>35 weeks) neonates in Intensive Care Unit-Fayoum Hospital - Egypt. Full neurological examination was done during the first 24 hours and after 7 days. Results: Severe hypoxic ischemia was found strongly correlated with high mortality. Low resistive index and high serum amyloid A were both indicators of poor prognostic condition in asphyxiated neonates. Conclusion: The serum amyloid A and ultrasound can be involved to evaluate the extent and level of asphyxia in neonates upon the first days of life.