Background: Neonatal seizures are the most common neurological emergency in newborns, often associated with significant mortality and long-term neurodevelopmental disabilities. The aim is to determine the incidence, etiological causes, and risk factors associated with neonatal seizures.Patients and Methods: This prospective case-control study was conducted over eight months, from January 1 to August 31, 2022, the study was conducted at the neonatal care unit of Children Welfare Teaching Hospital. Neonates who developed clinically recognizable seizures before 28 days of life in term infants, or up to 44 weeks corrected gestational age in preterm infants, were included. Data collection involved demographic information, prenatal, perinatal, and postnatal history, family history, seizure characteristics, physical examination including growth parameters, and relevant laboratory and radiological investigations. Follow-up was conducted two months later via phone interviews.Results: Among 180 neonates included, 50% had seizures while the remaining served as controls. The incidence of seizures among admitted neonates was 7.7%. The three main etiologies were birth asphyxia, infection, and metabolic disorders, each accounting for 25.6% of cases. The mean age at seizure onset was 9.3 ± 9.1 days, with a median of 5 days. Males were more affected (male-to-female ratio 1.57:1), and seizures were more common in term infants. Significant associations were found with family history of neurological disease and neonatal death. Vaginal delivery was more linked to birth asphyxia, while cesarean delivery was associated with neurological malformations. Mortality was three times higher in neonates with seizures.Conclusion: Birth asphyxia, infection, and metabolic disorders are leading causes of neonatal seizures. A positive family history and prematurity increase susceptibility. Early onset may indicate etiology, but seizure type does not predict cause. Seizure presence significantly increases neonatal mortality.