Abstract : Perinatal asphyxia is a transient interruption of oxygen availability that implies a risky metabolic challenge, even when the insult does not lead to a fatal outcome. In order to assess liver enzymes in neonates with perinatal asphyxia, and to correlate between the rise in enzymes to the severity of asphyxia. A case control study was carried out to measure serum liver enzymes in (43) full term neonates with perinatal asphyxia, aged 1-10 days who were admitted to the neonatal care unit. Fifty- seven neonates were selected as a control group. Patients were assessed at birth for their crying, breathing, Apgar score, gestational age, and underwent full physical and neurological examination. Assessment of the staging of asphyxia was done according to the Sarnat staging system. Serum liver enzymes; alanine aminotransferase (ALT), aspartate aminotransferase (AST) and alkaline phosphatase (ALP) were measured for patients and controls. Enzymes levels beyond +2SD above the mean of control group were regarded as high. Mean level of ALT, AST and ALP for asphyxiated neonates were (67.23±4.61, 89.02±7.99, 294.26±22.80) respectively and those for control group (21.60±3.71, 40.91±2.44, 201.49±11.63) respectively, the differences were statistically significant (p-value = 0.000). The rise in liver enzymes was related to the severity and staging of perinatal asphyxia in form of Apgar score and Sarnat staging, with statistically significant result, p-value < 0.05. liver enzymes were shown to be elevated in perinatal asphyxia and their assessment is important as a predictor for asphyxia