Asphyxia in neonates is characterized by different degrees of hypoxia-ischemia, with the outcome depending on the severity of the underlying brain cell damage. Neurotrophic factors rescue neurons from cell death after injury and promote neuronal survival during development. The authors have used enzyme-linked immunosorbent assay to study levels of nerve growth factor in the cerebrospinal fluid of children with asphyxia at birth (n = 10) and of controls (n = 23). Compared with reference groups the children who had had severe asphyxia had lower or negligible levels of cerebrospinal fluid nerve growth factor in the neonatal period or later. The level of cerebrospinal fluid nerve growth factor measured in the neonatal period was 3.76+/-4.13 pg/mL in children with asphyxia (n = 8), which is significantly lower than in children without asphyxia or infection (n = 10) 9.42+/-4.09 pg/mL or in those without asphyxia but with infection (n = 13) 17.63+/-11.48 pg/mL (P = 0.0186 and P = 0.0013, respectively). However, in some children with asphyxia the cerebrospinal fluid nerve growth factor levels were virtually normal, and most importantly these children subsequently had normal neurologic development. These results suggest that cerebrospinal fluid nerve growth factor might be used as a biochemical marker for early estimates of hypoxic-ischemic brain damage in asphyxiated neonates.