This observational study was carried out in the department of Paediatric Medicine and NICU of Dhaka Shishu Hospital during the period of July’2015 to June’2017. The main objective of this study was to observe the Significance of ECG changes in different stages of birth asphyxia and its correlation with Cardiac Troponin-I. A total of 75 neonates diagnosed as perinatal asphyxia with different stages of Hypoxic Ischemic Encephalopathy. Among the total 75 cases, ECG changes were seen in 32(42.66%) patients, remaining 43 babies had no change in ECG. Maximum changes were noticed among the cases with HIE stage-III 21(28.00%), followed by HIE stage-II 10(13.33%) and Stage-I 1(1.33%). Most common type of ECG abnormality was Grade-II changes which was present in 16 patients. This was followed by Grade-III type of changes, found in 9 patients and Grade-I type seen in 7 patients. No significant difference was seen among the neonates with HIE Stage-I, HIE stage-II and HIE stage-III groups with respect to parameters like birth weight, sex, gestational age, crown heel length (CHL), occipital frontal circumference (OFC), maternal age, and antenatal complications. Measurement of serum cardiac troponin I and determination of Myocardial performance index (Tei index), both are effective in assessment of myocardial dysfunction in asphyxiated neonates with HIE. Pearson’s Correlation Coefficient (r) test was done to see whether the two methods correlate in diagnosing myocardial dysfunction. Thorough clinical examination done with special attention to heart rate, blood pressure, and capillary refill time at admission and followed up till discharge or death. Blood pressure (systolic) was measured by auscultatory or flush method and plotted on blood pressure chart, capillary refill time (CRT) assessed by giving pressure over the sternum.