Introduction: Hypoxic-ischemic encephalopathy (HIE) describes the abnormal neurological state occuring in a newborn infant following a significant hypoxic- ischemic insult. The insult may occur antenatally, intrapartum or less commonly postnatally. In addition to signs of major CNS dysfunction, the affected infants may have problems with the pulmonary, cardiovascular, gastrointestinal and renal systems. Management involves prevention, adequate resuscitation, oxygenation, severity assessment and supportive management. Objectives :The aim is to study the differents risk factors , clinical presentations , complications , management and outcome of HIE patients in Cairo University NICU over one year starting from 1/4/2004 to 31/3/2005 with a comparative look between El Kasr El Eini and El Mounira as regards all these issues . Patients and Methods :Descriptive study involving all hypoxic ischemic neonates admitted into NICU of Cairo University Hospitals ( El Kasr El Eini and Mounira ),from l-4-2004to 31-3-2005 using SPSS version 15 to conduct analysis on IBM -compatible computer .Results: there was significant difference between both hospitals as regards : maternal medical and obstetric problems as anemia, multiple births, obstructed labour , fetal bradycardia and ROM > 24 hrs; fetal presentation and mode of delivery ;birth weight; Apgar score at 1 min; place of delivery ; symptomatology of patients : convulsions and respiratory distress ;outcome of ventilated HIE patients and their total mortality .Conclusion: the outcome was death in 42.7 % versus 57.3 % alive reflecting that prevention of HIE is definitely better than managing this neurological problem.