Neonatal seizures (NS) are generally an acute manifestation of disturbance of the developing brain and are very common in the first weeks of life. Many studies have been published concerning risk factors, etiology, identification, treatment and outcome of newborns with seizures, however, an important question as why the outcome is so diverse among neonates with seizures is still open to discussion. A literature review was performed with the help of the Medline database by crossing the key words neonatal seizures and outcome. From 1973 to 2005, 851 references were found and after screening title and abstract, 36 were selected, which could be identified as prospective studies that analyzed the risk factors and outcome of NS. The main risk factors for NS were prematurity, low birth weight, antenatal complications, meconium staining and need of subsequent respiratory support. The most frequent etiology reported in all studies was hypoxic ischemic encephalopathy. Mortality ranged from 12 to 61%. Clinical predictors of outcome were seizure type, onset, etiology and duration besides abnormal neonatal examination. The background rhythm of neonatal EEG was also a very good predictor of outcome. The incidence of epilepsy after neonatal seizures varied from 9.4 to 56%, most of the newborns that developed postneonatal epilepsy had epileptic syndromes with unfavorable prognosis. In conclusion, neonatal seizures seem to be associated with elevated morbidity and mortality directly related to the gravity of the encephalic injury.