Objective To explore the CT diagnostic features and clinical manifestations of neonatal hypoxic ischemic encephalopathy. Methods 37 cases of newborns with hypoxic ischemic encephalopathy who were born in the obstetrical department of our hospital during January 2014 to July 2015 were taken as the research objects. All the newborns received CT examination in postnatal 2 weeks. The results of clinical graduation were compared with the results of CT graduation and the CT imaging features of HIE were summarized. Results Among the 37 cases, the results of clinical graduation were mild in 11 cases, moderate in 21 cases and severe in 5 cases. The results of CT graduation were normal in 2 cases, mild in 9 cases, moderate in 20 cases and severe in 7 cases. The diagnostic accuracy of mild, moderate and severe were 77.8% (7/9), 80.0% (16/20) and 71.4% (5/7), respectively. CT manifested as diffused distribution of low density lesions in cerebral hemisphere white matter. CT value was between 16 - 20Hu and the boundaries were blurred. Conclusion The clinical manifestations of HIE are hyperexcitability, active primitive reflex, changes of muscular tension, drowsiness, loss of normal wake-sleep cycle and miosis, et al. CT examination can clearly identify the location and extent of HIE lesions and the condition of intracranial hemorrhage. It can grasp the severity of the disease to evaluate the pathogenetic condition. Through follow-up, the prognosis and outcome are evaluated, which plays an important role in clinical diagnosis and treatment.