The human brain is susceptible to a wide variety of genetic, developmental, and acquired abnormalities and insults. These brain injuries can occur prenatally, perinatally and/or neonatally, or postnatally. The spectrum of neurological compromise that may result from such insults extends from behavioural and learning disabilities to severe cerebral palsy. Neurological disability is the most feared complication of pregnancy, labour and the neonatal period. The cause and effect relationship, however, is often uncertain. For example, while perinatal asphyxia is certainly capable of causing cerebral palsy, most cases of cerebral palsy are not related to asphyxia. There is frequently a substantial gap in time between the onset of brain injury and the appearance and identification of the developmental handicap. Because of the incredible complexities in the brain, precise causal relationships between prior events and eventual outcomes frequently, cannot be reliably constructed. Recent investigations have made significant contributions in elucidating and managing this complex problem. Asphyxial injury to the foetal central nervous system is one of the most vital and yet highly controversial areas of concern in perinatal medicine. Recent advances in our understanding of the complex cellular and molecular mechanisms underlying cerebral hypoxic-ischaemic injury are presented. It is now recognized that hypoxic-ischaemic induced neuronal injury starts with neuronal energy failure and culminates in either immediate or delayed neuronal death. Delayed neuronal and glial death occurring in the hours and days after the insult by apoptotic and related processes offer the most promise for pharmacological intervention. These advances are not only altering our fundamental