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Background: Hypoxic Ischemic Encephalopathy (HIE) neonatorum is very important due to its high morbidity and mortality rates and long-term neuromotor outcomes. Methods: In order to evaluate outcomes in moderate to severe HIE, in a historical cohort study, medical records of all neonates with HIE during 1999-2006 in a university hospital were reviewed. Of 134 neonates who had been admitted, 94 cases could be evaluated and were in reach of follow-up. Results: A total of 77 deaths (81.9%) were found due to sequel of asphyxia. The survival rate was 17% with a median of 5 days. Of 17 alive neonates, 5 cases (29.4%) had cerebral palsy. The most important risk factors related to survival were: heart massage more than one minute, low first minute APGAR score, low PH in arterial blood gas analysis and low birth weight (P<0.05). Also emergency cesarean section was a major risk factor for death. Conclusion: HIE has high morbidity and mortality rates and needs urgent attention for implementation of prevention programs including more intensive intrapartum monitoring.