Background: Neonatal anesthesia demands a systematic understanding of the rapidly changing physiology of neonates, the pathology of coexisting diseases, and both the pharmacokinetics and the pharmacodynamics of the medications used to deliver the anesthesia. Aim: to compare general and spinal anesthesia for neonates regarding perioperative hemodynamics and complications. Patients and Methods: the single-blinded clinical trial included 36 patients randomly allocated into one of two groups. Group (A): Spinal anesthesia (SA) group received intrathecal bupivacaine 0.5% of dose 1 mg/kg for neonates weighing less than 5 kg and 0.4 mg/kg for those weighing > 5 kg. Group (B): General anesthesia (GA) group received inhalational sevoflurane for induction and sevoflurane for maintenance of anesthesia with paracetamol 15 mg/kg IV for analgesia of patients. Results: Intraoperative hemodynamics were significantly better and more stable in the SA group than that in the GA group. Complications during surgery occurred in one patient in the SA group, in the form of a bloody tap, while in the GA group, two patients had hypoxia. The intra-operative complications were not significant between the two groups. Post-operative complications were statistically significantly lower in the SA group compared to the GA group (P-value < 0.05). Postoperative heart rate (HR) was statistically significantly lower in the SA group compared to the GA group (P-value < 0.05). Conclusion: Spinal anesthesia is a good alternative to general anesthesia in neonates for infraumbilical surgeries.