BACKGROUND: 1. Professor E.E.U Akang 2. Dr I.A. Lagunju Birth asphyxia is the third major cause of neonatal death after infections and preterm births in developing countries, but there have been no previous post-mortem studies to document the morphological central nervous system changes among babies with birth asphyxia in this environment AIM: To determine morphological patterns of central nervous system changes following birth asphyxia and to ascertain the proportional mortality of neonatal deaths due to birth asphyxia. METHODS: Fifty cases including foetuses that were stillborn and neonates with Apgar score of less than 7 at 5 minutes that subsequently died during the neonatal period between January 2006 and February 2007 were autopsied. The gender, gestational age, weight, crown-heel length, the booking status of the mothers and the underlying clinical condition were noted. The gross and microscopic central nervous system changes were documented. These indices were subjected to statistical analysis using Chi square test. RESULTS: The major morphological findings were subarachnoid, subgaleal, intraventricular and subdural haemorrhages. Important microscopic lesions were germinal matrix haemorrhage, spongiform change of the white matter, basal ganglia and the cortex. Involvement of the parasagittal region and cortical spongiform change were more significant in males than females (p = 0.004) and (p = 0.019) respectively. However caudate nucleus involvement was more significant in females (p = 0.022). Intraventricular haemorrhage and germinal matrix haemorrhage were both associated with significantly shorter survival among children with birth asphyxia (p = 0.004) and (p = 0.004) respectively. The proportionate mortality of neonatal deaths due to birth asphyxia was 24.9%. CONCLUSION: Morphological central nervous system changes following birth asphyxia as documented by this study do not differ significantly from changes that have been noted from previous studies done in other countries