Magnetic resonance spectroscopy (MRS) and near-infrared spectroscopy (NIRS) are capable of providing detailed information on cerebral oxidative metabolism in infants who have been resuscitated following an acute asphyxial episode. In severely affected infants studied by phosphorus and proton MRS, a consistent observation has been the development of deranged cerebral energy metabolism 12-48 hours after resuscitation, despite the maintenance of cardiovascular and respiratory homeostasis. Follow-up studies have indicated that the development of delayed energy failure is closely associated with the development of microcephaly and an adverse neurodevelopmental outcome. This pathophysiologic sequence has been modelled in newborn animals, allowing the mechanisms of delayed energy failure to be elucidated and cerebroprotective treatments to be tested. New developments in MRS and magnetic resonance imaging will enable quantitative and highly localised information on cerebral metabolism to be obtained in asphyxiated infants, increasing the accuracy of early clinical assessment. Significant cerebral vasodilatation and vasoparalysis of the cerebral circulation have been observed by NIRS in asphyxiated infants following resuscitation, but the prognostic value of this observation remains uncertain. Technical advances in NIRS are likely to improve the reproducibility and accuracy of the technique, allowing the assessment of regional cerebral haemodynamics and metabolism at the bedside.