Background: Birth asphyxia is a global health crisis causingsignificant neonatal mortality and morbidity. Defined by the failure to initiate breathing at birth, it is clinically identified via low APGAR scores. While many maternal and fetal risk factors are preventable, localized research on its prevalence and causes remains insufficient within Ethiopia. Objective:The objective of this study to determine the proportion of perinatal asphyxia and its associated factors among neonate visited to neonatal OPD of Tibebe-Gion specialized hospital. Method: This institutional-based retrospective cross-sectional study was conducted at Tibebe-Ghion Specialized Hospital, Bahir Dar, from January 1, 2025 to February 21, 2026 G.C. The study included neonates admitted to the NICU between June 29, 2024 and June 28, 2025 G.C. The sample size was determined using a single population proportion formula (p = 23.07%), with finite population correction applied (N = 1,538), yielding a final sample of 254. Systematic random sampling was employed. Data were collected using a standardized chart abstraction tool. Data were entered into EpiData and analyzed using SPSS version 26 with multivariable logistic regression at p < 0.05 significance level. Result: This study at Tibebe-Ghion Specialized Hospital found an 11.67% (95% CI: 8.3–15.1%) proportion of perinatal asphyxia among 240 neonates. The number of respondent was 240(94.5%) Fetal malposition (AOR=0.11, 95%CI: 0.04–0.31), preeclampsia/eclampsia(AOR=0.15, 95%CI: 0.05–0.44), rupture of membranes (AOR=0.16, 95%CI: 0.056–0.476), and meconium-stained fluid (AOR=0.16, 95%CI: 0.06–0.48) were significant independent predictors. Conclusion and recommendations:Perinatal asphyxia remains a significant neonatal problem at TGSH, strongly associated with antepartum and intrapartum complications. Strengthening ANC follow up, labor monitoring, ensuring partograph use, improving neonatal resuscitation