Journal article
Amplitude integrated electroencephalography for neonatal seizure detection: an alternative opinion to the 2025 Cochrane review
Pediatric research
03/19/2026
DOI: 10.1038/s41390-026-04916-6
PMID: 41857387
Abstract
Amplitude-integrated electroencephalography (aEEG) is widely used in neonatal intensive care units for bedside neuromonitoring, seizure detection, prognostication, and guidance of therapeutic hypothermia. A recent Cochrane systematic review comparing aEEG with conventional video-electroencephalography (cEEG) questioned the value of aEEG for neonatal seizure detection. However, careful interpretation of these findings is warranted. This commentary highlights key methodological limitations of the review, including the inclusion of studies without raw EEG display, heterogeneity in electrode configurations, inconsistent reporting of interpreter expertise, and variable seizure definitions. These factors likely bias pooled estimates toward underestimating the performance of modern aEEG systems when used according to contemporary standards. We emphasize that aEEG should not be evaluated as a substitute for cEEG, but as a complementary bedside modality. Beyond seizure detection, aEEG provides clinically meaningful information through background assessment, early prognostication in hypoxic–ischemic encephalopathy, and longitudinal trend monitoring, particularly in settings where cEEG is unavailable. We conclude that dismissing aEEG technology based on methodologically limited comparisons risks undervaluing an important and pragmatic neuromonitoring tool. Future research and guidelines should prioritize optimized application, standardized protocols, training, and integration with emerging analytic approaches, including artificial intelligence, to support equitable neonatal neurocritical care worldwide.
Details
- Title: Subtitle
- Amplitude integrated electroencephalography for neonatal seizure detection: an alternative opinion to the 2025 Cochrane review
- Creators
- Gabriel F T Variane - Brain Mapping FoundationKrisa Van Meurs - Stanford UniversityLinda S de Vries - Leiden University Medical CenterSonia L Bonifacio - Stanford UniversityGeraldine B Boylan - University College CorkLina Chalak - The University of Texas Southwestern Medical CenterRobert Clancy - Children's Hospital of PhiladelphiaMohamed El-Dib - Center for Pain and the BrainGorm Greisen - University of CopenhagenRod W Hunt - Cerebral Palsy AllianceTerrie Inder - Children's Hospital of Orange CountyKatrin Klebermass-Schrehof - Comprehensive Cancer Center ViennaPatrick J McNamara - University of IowaAdam L Numis - University of California, San FranciscoElizabeth Sewell - Emory UniversityDivyen K Shah - Queen Mary University of LondonEilon Shany - Ben-Gurion University of the NegevMiklos Szabo - Semmelweis UniversityMarianne Thoresen - University of OsloSampsa Vanhatalo - University of HelsinkiLaishuan Wang - National Health and Family Planning CommissionLena Hellström-Westas - Uppsala University
- Resource Type
- Journal article
- Publication Details
- Pediatric research
- DOI
- 10.1038/s41390-026-04916-6
- PMID
- 41857387
- NLM abbreviation
- Pediatr Res
- ISSN
- 1530-0447
- eISSN
- 1530-0447
- Publisher
- Springer Nature
- Grant note
- Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior - Brasil (CAPES)
The Article Processing Charge (APC) for the publication of this research was funded by the Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior - Brasil (CAPES) (ROR identifier: 00x0ma614).
- Language
- English
- Electronic publication date
- 03/19/2026
- Academic Unit
- Stead Family Department of Pediatrics; Neonatology
- Record Identifier
- 9985147088502771
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