Background: Infants with perinatal brain injury are at risk of later visual problems. Advanced neuroimaging techniques show promise to detect functional and structural alterations of the visual system. We hypothesized that infants with perinatal brain injury would have less brain activation during a visual functional magnetic resonance imaging (fMRI) task and reduced task-based functional connectivity and structural connectivity as compared with healthy controls. Methods: Ten infants with perinatal brain injury and 20 control infants underwent visual fMRI and diffusion tensor imaging (DTI) during natural sleep with no sedation. Activation maps, functional connectivity maps, and structural connectivity were analyzed and compared between the two groups. results: Most infants in both groups had negative activation in the visual cortex during the fMRI task. Infants with brain injury showed reduced activation in the occipital cortex, weaker connectivity between visual areas and other areas of the brain during the visual task, and reduced fractional anisotropy in white matter tracts projecting to visual regions, as compared with control infants. conclusion: Infants with brain injury sustained in the perinatal period showed evidence of decreased brain activity and functional connectivity during a visual task and altered structural connectivity as compared with healthy term neonates. i nfants with brain injury sustained in the perinatal period are at risk of later visual problems, including low visual acuity, decreased binocular depth perception, abnormal eye movements, and cortical visual impairment (1,2). The ability to predict visual outcome based on conventional imaging and ophthalmologic examinations in the neonatal period is poor (1,3,4). Therefore, children with brain injury who could benefit from early ophthalmologic assessment and early intervention vision therapies may have delayed diagnosis and treatment of visual problems. As advanced neuroimaging techniques have become more common, the visual system has been studied in preterm and term infants. Using task-based fMRI, occipital lobe activation is reliably obtained in infants after term equivalent age (5,6) but not in the preterm period (7). Functional connectivity of the visual system in the neonatal period using task-based fMRI has not been previously reported. Diffusion tensor imaging (DTI) studies have shown that altered white matter integrity of the optic radiations is related to visual function in preterm infants (8), and volumetric analyses have correlated reduced occipital volumes in the neonatal period with later impaired oculomotor function (9).Our long-term, overarching goal is to determine whether fMRI and DTI can be used as an adjunct to conventional clinical MRI to add additional information for clinicians and families about potential damage to the visual system in the neonatal period. In this study, we performed DTI and visual fMRI with a flashing light stimulus in 20 term control infants <8 wk postnatal age and in 10 infants with brain injury ...