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The birth of an infant who has a possible hypoxic ischaemic encephalopathy (HIE) is a source of great concern to the parents, obstetricians and paediatricians. Hypoxic cerebral brain injury that occurs in the perinatal period is recognised as a cause of severe long-term neurological deficit in children; it is often referred to as cerebral palsy. The absence of information and specific guidelines on HIE means that advice provided to women has to be collated from evidence-based effective antenatal and perinatal care that maximises the opportunity to deliver a healthy baby. Approaches to the prevention of HIE include the antenatal administration of corticosteroids to women in preterm labour, as this has been shown to reduce perinatal mortality, respiratory distress and intraventricular haemorrhage by over 50%. All units should have a regular continuing programme of in-service training including cardiotocography (CTG) interpretation, drills on emergency ('crash') caesarean section and neonatal resuscitation.