This study investigated treatment patterns at discharge in infants with neonatal seizures and evaluated the impact of outpatient phenobarbital prophylaxis on the frequency of seizure recurrence and the long-term neurodevelopmental outcome at 1 to 11 years. Infants with neonatal seizures during a 12-year period were identified retrospectively (n = 146), and data were obtained by medical chart review. Outcomes were ascertained by standardized telephone survey. Thirty-three infants (23%) were taking phenobarbital, and 99 infants (68%) were taking no anticonvulsants at discharge. Comparisons were made between these 2 groups. Phenobarbital prophylaxis did not improve neurologic outcomes, either with respect to seizure recurrence or neurologic development. These data have important implications at a time when many are questioning the practice of prophylaxis after neonatal seizures and when newer anticonvulsants are being recommended for treatment of acute neonatal seizures.