Acute cerebrovascular injury in term and preterm infants is a cause of significant morbidity. Treatment efforts in the past have focused on attempts to prevent such injury by interceding during labor in term infants and improving neonatal care in preterm infants. Epidemiologic studies suggest that these strategies have had little impact. A new strategy--drug treatment of acute ischemic brain injury--is on the horizon. The recognition and prognostication in ischemic neonatal brain injury takes on a new importance in this light.