Background: South Africa aims to end all preventable deaths of children under the age of five as part of their commitment to the Sustainable Development Goals. More than half of these mortalities occur in the neonatal period with perinatal asphyxia as one of the leading causes. This study investigated and identified the characteristics of perinatal asphyxia and its contributing factors at a district hospital in Cape Town. Methods: A retrospective descriptive case series was performed and included all suspected cases of perinatal asphyxia referred from Mitchells Plain District Hospital (MPH)) to a specialised centre in the years 2016-2018. A data collection tool was used to extract information. Data was processed with SPSS to produce descriptive statistics and to investigate associations between variables using the Chi-square tests. Results: The study included 29 cases of suspected perinatal asphyxia. Ten (34.5%) had abnormal amplitude Electroencephalograms (aEEG's) indicative of Hypoxic Ischaemic Encephalopathy (HIE) and four (13.8%) demised before day seven of life. Non-operative deliveries (p=0.005), lack of a doctor at the time of delivery (p=0.004) and neonatal chest compressions (p=0.044) were associated with abnormal aEEG's. Babies with Thompson score of equal to or more than 12 (p=0.006), neonatal seizures (p=0.036) and delayed arrival at referral hospital (p=0.005) were associated with abnormal aEEG findings. Mortality was associated with Thompson score ≥12 (p=0.007) and the need for neonatal intubation at delivery (p=0.016). Conclusions: Significant reversable factors were identified in the peri-and postpartum periods. More capacitated staff would have the greatest impact on outcomes. The profile of HIE is exceedingly complex and challenges the resources and services of district level of care. Therefore, these factors should be targeted for future development and investment to improve outcomes from district hospitals.