Encephalopathy occurring soon after birth continues to be a major complication in near- and full-term newborn infants. Early neonatal encephalopathy is most likely to be due to perinatal hypoxia–ischaemia, but precise criteria supporting hypoxia–ischaemia should be applied when defining this syndrome. Careful clinical assessment together with specific investigations allows precise assessment of prognosis during the first few days after birth. MRI is the best method available for confirming the diagnosis and predicting specific patterns of outcome in babies with perinatal hypoxia–ischaemia. Management of infants with hypoxic–ischaemic encephalopathy is largely supportive, but current studies indicate that mild/moderate hypothermia may increase the chance of survival without disabilities up to 18 months of age.