Early Electroencephalography and Amplitude-Integrated Electroencephalography for the Prediction of Neurodevelopmental Outcomes in Neonates with Hypoxic Ischemic Encephalopathy: A Systematic Review and Diagnostic Test Accuracy Meta-analysis.

Abstract

Introduction: Electroencephalography (EEG), including both conventional EEG (cEEG) and amplitude-integrated EEG (aEEG), are early prognostic tools utilized in neonates with hypoxic ischemic encephalopathy (HIE). However, the reported predictive accuracy of EEG varies widely.

Methods: We evaluate the diagnostic accuracy of EEG in predicting neurodevelopment impairment (NDI) among neonates > 35 weeks with any stage HIE. MEDLINE, Embase, Cochrane Library and Scopus were searched from inception until 24th December 2024. Observational studies evaluating EEG performed in the first 72 hours of life in neonates with HIE, and reporting NDI outcomes assessed after 12 months were included. Two authors independently extracted data. A Bayesian random-effects bivariate model was used for diagnostic test accuracy meta-analysis. Risk of bias was assessed using QUADAS-2, and certainty of evidence (CoE) with GRADE. NDI, defined as cognitive/motor scores <1 SD below the mean or presence of motor disability.

Results: 62 studies (n=3929) were included. In neonates who underwent therapeutic hypothermia (TH) (34 studies, n=2538), EEG showed a sensitivity of 88.3% (95% Credible Interval(CrI): 83.7%, 92.8%) and specificity of 63.9% (53.6%, 72.8%). In no TH group (33 studies, n= 1,391), the sensitivity was 87.2% (77.5%, 93.5%) and specificity was 76.3% (61.5%, 86.8%). Further, in neonates who received TH (12 studies, n=868), cEEG had an acceptable sensitivity of 84.1% (77.3%, 89.9%) and specificity of 76.7% (66.9%, 84.3%). CoE being predominantly moderate.

Conclusion: EEG has good sensitivity in predicting NDI regardless of TH status, and may aid in identifying high-risk neonates for further evaluation.