BACKGROUND: Perinatal asphyxia is one of the leading causes of neonatal morbidity and mortality in the world. While there is much published data on the epidemiology of perinatal asphyxia in African countries, there is a lack of data on this topic in Sudan, which is the third-largest country in Africa. This study aimed to determine the prevalence of perinatal asphyxia and its associated factors among neonates delivered at Saad Abuelela Maternity Hospital, Sudan. METHODS: A cross-sectional study was conducted in Saad Abuelela Maternity Hospital, Sudan. Questionnaires were used to collect maternal sociodemographic, obstetric, and clinical data. The neonates' clinical data (birth weight, sex of newborn, and Apgar score) were also collected and recorded. Multivariate binary analysis was performed. RESULTS: Six hundred and nineteen mother-neonate pairs were included in the study. The mothers' median (IQR) age and parity was 27.0 (23.0-32.0) years and 3(1-5), respectively. Seventy (11.3%) neonates had perinatal asphyxia. In univariate analysis, the odds of perinatal asphyxia were increased in employed mothers, rural residents, cesarean delivery, preterm infants, and low birth weight neonates. There was no association between age, parity, mother education, mother anemia, sex of the neonates, and perinatal asphyxia. In multivariate analysis, the odds (adjusted) of perinatal asphyxia were increased in cesarean delivery (adjusted odds ratio [aOR] = 2.31, 95.0% CI [confidence interval] = 1.33‒4.02), preterm delivery (AOR = 6.37, 95.0% CI = 2.34‒7.95) and low birth weight (aOR = 2.29, 95.0% CI = 1.26‒4.18). CONCLUSION: There was a high prevalence of perinatal asphyxia among newborns delivered at Saad Abuelela Maternity Hospital, Sudan. The factors associated with perinatal asphyxia among neonates were cesarean delivery, low birth weight, and preterm birth.