BACKGROUND Perinatal asphyxia is an insult to the foetus or newborn due to lack of oxygen (hypoxia) and/or lack of perfusion (ischaemia) to various organs, of sufficient magnitude and duration to produce more than fleeting functional and/or biochemical changes. There are various studies available to indicate foetal asphyxia like intrapartum electronic foetal monitoring, foetal or umbilical cord pH measurement, Meconium-Stained Amniotic Fluid (MSAF), APGAR score, Hypoxic-Ischaemic Encephalopathy (HIE) and evidence of multiorgan dysfunction. But in a resource-limited institute a need for simpler and cheaper alternatives are sought. In this prospective analysis, we report our experience with a study on nucleated RBC (nRBC) count and its association with foetal asphyxia and its immediate neurological outcome in term newborns in RIMS Hospital, Imphal, Manipur. The objective is to study the association between the nucleated RBC count and foetal asphyxia and its immediate neurological outcome in term newborns. MATERIALS AND METHODS In this case-control study conducted over 2 years in a tertiary care referral hospital in Manipur, India, 50 asphyxiated (study group) and 50 non-asphyxiated (control group) neonatal cord blood samples were randomly selected and analysed. RESULTS nRBC counts were significantly higher in those with meconium-stained amniotic fluid (MSAF) (12.66 ± 6.17) than in normal amniotic fluid group (9.25 ± 5.88). nRBC/100 WBCs were also significantly elevated in asphyxiated newborns (14.10 ± 4.79) in comparison to non-asphyxiated group (5.44 ± 3.47). As the stage of Hypoxic-Ischaemic Encephalopathy (HIE) increased from grade I (9.4 ± 4.57) to grade III (21 ± 2.94), nRBC count also increased in frequency showing a direct proportion. CONCLUSION In limited health care settings, nRBC count can be an easy and economical alternative for detecting perinatal asphyxia and also the severity of HIE.