Objective To investigate the long-term neurodevelopmental outcomes of neonates with different types of stroke. Methods Data from 41 neonates diagnosed with stroke at the Third Affiliated Hospital of Zhengzhou University between January 2017 and May 2024 were retrospectively reviewed. Stroke types included arterial ischemic stroke (AIS), hemorrhagic stroke (HS), and cerebral sinovenous thrombosis (CSVT). All infants were followed to 2 years of age. Neurodevelopmental outcomes were assessed using the Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III), focusing on motor and cognitive development. Outcomes were compared according to vascular involvement. Results Of the 41 neonates, 35(85%) had AIS, 5(12%) had HS, and 1(2%) had CSVT. Among the 35 AIS cases, 16(46%) involved the main trunk of the middle cerebral artery (MCA). The incidences of cerebral palsy (CP) and cognitive developmental delay were significantly higher in the MCA main trunk group than in the non-main-trunk group (P<0.05). Among the 5 HS cases, 1 involving the frontal cortical branch of the MCA died at 12 days of life. Two cases involving the temporal cortical branches had BSID-III cognitive development indices of 102 and 106, and motor development indices of 90 and 95 at 2 years. The remaining 2 cases involving the MCA main trunk developed CP. The single CSVT case involved the great cerebral vein and presented with CP and language developmental impairment. Conclusions AIS is the most common type of neonatal stroke and shows poorer outcomes by 2 years of age. Early identification and early intervention are essential in clinical practice.