Background: Hypoxic Ischemic Encephalopathy is a subcategory of neonatal encephalopathy defined as a heterogeneous, clinically distinct syndrome characterized by disturbed neurological function, abnormal muscle tone and respiratory problems in the neonatal period in term infant, presented by a decreased level of consciousness, convulsions, decreased alertness, and often accompanied by difficulty with initiating and maintaining respiration. MRI plays an increasing important role for imaging the neonatal brain and follow up of neonates with HII. MR spectroscopy allows immediate analyses of the metabolites in the neonatal brain and also serves important role in assessment of neurological outcome and prognosis.  The utility of proton MR spectroscopy could detect brain ischemic injuries in neonates with HII earlier than T2- or T1- weighted MR sequences. Diffusion-weighted imaging has the highest sensitivity for early detection of brain injury in neonates with HII. Findings seen at diffusion-weighted imaging mostly peak at 3–5 days after the insult of brain injury and then gradually normalize. 
Conclusions:   MR spectroscopy is an accurate, sensitive and non-invasive method for early detection of perinatal ischemic brain injuries.