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Arterial cord blood gas analysis reveals the newborn’s acid–base status at birth, reflecting whether hypoxia and ischemia occurred during labor. When asphyxia happens, tissue oxygen delivery is inadequate, driving anaerobic metabolism and lactic acid production. This creates metabolic acidosis, which shows up as a low pH and a negative base excess (or high base deficit) on the cord arterial gas, sometimes with elevated lactate. Because this pattern directly documents hypoxic–ischemic stress at the moment of birth, it best predicts perinatal asphyxia. Neonatal sepsis, hypoglycemia, and maternal infection involve different mechanisms and time courses and are not identified primarily by the cord gas pattern.