<jats:title>Abstract</jats:title>
          <jats:sec>
            <jats:title>Background</jats:title>
            <jats:p>While birth asphyxia is a well-established cause of neonatal seizures associated with adverse outcome, less is known about outcomes after seizures in non-asphyxiated infants. We investigated adverse outcomes following neonatal seizures in infants born vigorous and without evidence of asphyxia.</jats:p>
          </jats:sec>
          <jats:sec>
            <jats:title>Methods</jats:title>
            <jats:p>Swedish national cohort (2009–2015) including 656,088 live-born term vigorous infants. The exposure was a diagnosis of neonatal seizure. A combined adverse outcome included any diagnosis of cerebral palsy, epilepsy, intellectual and developmental disability, or death. Hazard ratios (HR) with 95% confidence intervals (CI) were calculated.</jats:p>
          </jats:sec>
          <jats:sec>
            <jats:title>Results</jats:title>
            <jats:p>470 infants were diagnosed with seizures, and 299 (64%) had EEG-verified seizures. Among those with the combined adverse outcome, 75% were diagnosed the first year, corresponding to an incidence of 178 per 1000 of all infants and 224 per 1000 among EEG-verified cases. The one-year incidence rates were 220 per 1000 child years for all, and 283 per 1000 child years among those EEG-verified compared to 2.3 per 1000 child years without seizures. The HR for all seizures within 1 year was 95 (77–120), and for EEG-verified seizures 120 (96–160).</jats:p>
          </jats:sec>
          <jats:sec>
            <jats:title>Conclusion</jats:title>
            <jats:p>This study demonstrates a strong association between neonatal seizures and adverse long-term outcome in vigorous term infants without asphyxia.</jats:p>
          </jats:sec>
          <jats:sec>
            <jats:title>Impact</jats:title>
            <jats:p>
              <jats:list list-type="bullet">
                <jats:list-item>
                  <jats:p>Term infants who were vigorous and non-asphyxiated at birth but later developed neonatal seizures faced a significant elevated risk of adverse outcomes, including death, cerebral palsy, epilepsy, intellectual and developmental disabilities.</jats:p>
                </jats:list-item>
                <jats:list-item>
                  <jats:p>Among these adverse outcomes epilepsy was the most frequent and was predominantly diagnosed during the first year of life.</jats:p>
                </jats:list-item>
                <jats:list-item>
                  <jats:p>Population-based studies utilizing national health and quality registers can greatly enhance our understanding of long-term outcomes following neonatal seizures.</jats:p>
                </jats:list-item>
              </jats:list>
            </jats:p>
          </jats:sec>