Our aim is to recruit a cohort of infants with clearly defined perinatal asphyxia and HIE, classified using both repeated neurological assessment and multichannel EEG. At the time of birth, umbilical cord blood will be drawn, processed and banked, using strict standard operating procedures (SOPs) which we have developed for this purpose. These procedures will ensure that all specimens will be suitable for later proteomic, metabolomic, transcriptomic and genomic analysis. Using a systems biology approach we have studied multiple proposed markers in the stored umbilical cord blood from our discovery cohort, initially focusing on the proteome and metabolome. Through this work we have already identified a number of biomarkers present in umbilical cord blood with the potential to predict the development of moderate/severe HIE. Our early data is extremely promising. Our initial metabolomic analysis has shown that we can differentiate between HIE and controls with an area under the curve (AUROC) of 0.92. Further analysis will be required to identify and quantify the exact metabolite peaks which produce this differentiation. We now wish to validate these findings in a further cohort of infants with perinatal asphyxia and HIE, and to validate our ability to predict longer term neurological outcome. Our pilot work examining microRNA changes in the cord blood of infants with moderate/severe HIE is also very encouraging with significant upregulation of a multiple studied miRNAs in both asphyxia and HIE. The most promising miRNAs are now being quantified using polymerase chain reaction (PCR) amplication and will be validated in the discovery cohort.