Objective To analyze the brain CT features of perinatal asphyxia in preterm infants. Methods The clinical data of 50 neonates with perinatal asphyxia were analyzed retrospectively. Brain CT findings,neonatal behavioral neurological assessment (NBNA) scores and CT value of brain white matter were compared between infants of different gestational age (26 premature infants, 24 term infants) and infants with different degrees of asphyxia. Results There were diffusely reduced density of cerebral parenchyma (CT value < 16Hu) and subarachnoid hemorrhage in 26 premature infants. There were cortical and subcortical white matter low-density lesions (CT value < 18Hu), involvement of periventricular white matter and subarachnoid hemorrhage in 24 term infants. The NBNA score and CT value of white matter of premature infants were lower than those of term infants (P<0.05). The NBNA score and CT value of white matter of mild asphyxia group were higher than those of severe asphyxia group (P<0.05), while the rate of white matter damage was lower than that in severe asphyxia group (P<0.05). The NBNA score was positively correlated with the CT value of white matter in premature infants with perinatal asphyxia (r=0.352, P<0.05). Conclusion Asphyxia has different pathological damage to brain tissues at different stages of development. CT lesions in premature infants with perinatal asphyxia is mainly located in brain white matter around the ventricles. With the aggravation of asphyxia, white matter damage becomes more severe.