In the modern era various biochemical markers are used to establish the diagnosis of perinatal asphyxia and validate the prognosis. Neuron specific enolase, IL-6, glial fibrillary acidic protein, urinary lactate/ creatinine ratio are various markers used to determine the neurodevelopmental outcome. Estimation of interleukin and enzyme require modernized equipment’s, expert manpower, and are expensive. Uric acid and creatinine are metabolites, excreted in the urine, the estimation of which is both time and cost effective. Various studies done in the recent past have proved the utility of uric acid/ creatinine ratio as a marker of neonatal asphyxia. The present study was planned to describe prospectively urinary uric acid to creatinine ratio in perinatal asphyxia and showing increased uric acid and creatinine excretion in early spot urine for identification of perinatal asphyxia. 30 Neonates attending the SNCU, Paediatrics Department, Darbhanga Medical College & Hospital, Laheraisarai, Bihar were selected randomly for the present study. Out of them 15 cases were diagnosed as neonatal asphyxia and the other 15 cases were normal neonates. Perinatal asphyxia is one of the major causes of neonatal mortality and morbidity. It is an important cause of static development and neurological impairment. So early detection and treatment can significantly reduce morbidity and mortality. From the present study it is concluded that urinary uric acid/ creatinine ratio is significantly high in babies with birth asphyxia. There is significant negative linear correlation between urinary uric acid/ creatinine ratio and Apgar score at 1 minute, 5 minutes and 10 minutes.