Objective: To compare urinary uric acid and creatinine ratio (UUA/Cr) among asphyxiated and nonasphyxiated neonates. Background: Perinatal asphyxia is the leading cause of neonatal morbidity and mortality. The last few decades have seen many improvements in modern medicine but still, there is a lack of easily available biochemical markers to diagnose perinatal asphyxia more so in institutional deliveries. Study design: Cross-sectional, comparative study. Setting: NICU and postnatal wards of tertiary care center. Participants: Forty asphyxiated and 40 healthy term newborns were enrolled in the study. Two milliliters of cord arterial blood was collected for a blood gas analysis in asphyxiated neonates only. Spot urine samples were collected within the first 24 hours of life in both asphyxiated and nonasphyxiated groups and analyzed for UUA/Cr ratio. Results: The mean UUA/Cr ratio was found to be higher in asphyxiated (2.41 ± 0.58) than in nonasphyxiated neonates (1.58 ± 0.17) (p <0.001). There was a positive correlation between the UUA/Cr ratio and the severity of hypoxic–ischemic encephalopathy among asphyxiated neonates (p <0.001). A negative correlation was found of UUA/Cr ratio with Apgar score and umbilical cord blood pH. The cutoff value of the UUA/Cr ratio of 1.36 has 97.5% sensitivity, 100% specificity, 100% positive predictive value, 97.5% negative predictive value, and 98.7% accuracy. Conclusion: This ratio can be used as a reliable diagnostic marker to detect perinatal asphyxia in neonates where adequate birth history is not available.