Introduction: Asphyxia is a major cause of neonatal intensive care unit (NICU) admission and the second leading cause of morbidity and mortality in term and preterm neonates. In poor countries, the prevalence of asphyxia ranges from 5 to 10 per 1000 live births (Zhang et al, 2020). The hypoxic ischemic phenomenon does not always occur after birth, accounting for only 10% of all cases. The majority of cases occur before birth (20%) and during delivery (33%), respectively (Glass and Ferriero 2007). Acute kidney injury (AKI) affects 30-55 percent of asphyxiated neonates, with a 60-66 percent mortality rate (Beck et al 2010). AKI has largely replaced acute renal failure (ARF) because it better defines renal dysfunction as a continuum rather than a discrete finding of failed kidney function. AKI is defined as a sudden loss of kidney function that results in a decrease in glomerular filtration rate (GFR), retention of urea and other nitrogenous waste products, and dysregulation of extracellular volume and electrolytes (Devarajan 2013). Diagnosis of AKI in neonates is difficult because most clinical and biochemical parameters are independent at this age. Serial measurements of kidney function biomarkers such as serum creatinine are currently used to make the diagnosis in approximately 30% of critically ill neonates and children who suffer from AKI and its consequences (EL-Wakeel et al,.2012). Serum creatinine is frequently a delayed and imprecise test because it reflects GFR in individuals who are in a steady state with stable kidney function and does not accurately reflect GFR in a patient whose renal function is changing. A neonate in the early stages of severe AKI with a markedly reduced GFR, for example, may have a relatively normal or slightly elevated creatinine because there hasn't been enough time for creatinine accumulation (Kaddourah et al, 2019). Novel AKI biomarkers have the potential to not only diagnose AKI earlier than changes in serum creatinine, but also to predict the development of AKI, distinguish the aetiology of the AKI, and predict the likelihood of adverse post-AKI short and long-term outcomes (Jason and Chirag 2017). Neutrophophil gelatinase-associated lipocalin (NGAL), kidney injury molecule 1 (KIM-1), interleukin 18 (IL-18), liver-type fatty acid-binding protein (L-FABP), neutrophil elastase-2 (Ela-2) and cystatin C (Cys-C) are some of these biomarkers (Rizivi and kashani 2017). NGAL is a lipocalin family protein that is widely expressed and serves as a bacteriostatic agent in the innate immune response. Following renal injury, NGAL production is dramatically increased (Dai et al, 2015). Definition: Perinatal asphyxia (also known as neonatal asphyxia or birth asphyxia) is the medical condition resulting from deprivation of oxygen to a newborn infant that lasts long enough during the birth process to cause physical harm, usually to the brain. It remains a serious condition which causes significant mortality and morbidity (Truwit and Barkovich 2009). It is also an insult to the fetus or newborn due to lack of oxygen or lack of perfusion to various organs and may be associated with a lack of ventilation. In accordance with WHO, it is characterized by profound metabolic acidosis, with a pH less than 7.20 on umbilical cord arterial blood sample, persistence of an Apgar score of 3 at the 5th minute, clinical neurologic sequelae in the immediate neonatal period, or evidence of multiorgan system dysfunction in the immediate neonatal period. Epidemiology: The world health organization (WHO) estimates that 3% of the 120 million infants born in low-income countries suffer from perinatal asphyxia (Kiyani 2014). Perinatal asphyxia accounts for 280,000 deaths of newborns on the first day of life in Africa. Several previous studies showed high prevalence rates of perinatal asphyxia in African countries. Maternal diseases such as hypertensive disorder of pregnancy and diabetes mellitus, as well as perinatal factors such as low birth weight and seizure, are the main risk factors for perinatal asphyxia (Mamo et al, 2022). Several previous studies showed that labour problems and low birth weight were the main factors associated with perinatal asphyxia in sub-Saharan Africa (Halloran et al, 2009). A recent study done by (Ahmed MAA., et al 2022) conducted in Sudan aimed at identifying neonatal mortality and associated factors in the neonatal intensive care unit of Gadarif Hospital revealed that 21.0% of the neonates died because of perinatal asphyxia. Diagnosis of Perinatal asphyxia: The guidelines of the American Academy of Pediatrics (AAP) and the American College of Obstetrics and Gynecology (ACOG) consider all of the following criteria in diagnosing asphyxia: (i) profound metabolic or mixed acidemia (pH

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