{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T14:25:44Z","timestamp":1783175144300,"version":"3.54.6"},"reference-count":15,"publisher":"Georg Thieme Verlag KG","issue":"10","license":[{"start":{"date-parts":[[2020,12,15]],"date-time":"2020-12-15T00:00:00Z","timestamp":1607990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:p>\n            Objective\u2003The aim of the study is to model amplitude-integrated electroencephalography (aEEG) utility to diagnose seizures in common clinical scenarios.<\/jats:p><jats:p>\n            Study Design\u2003Using reported neonatal seizure prevalence and aEEG sensitivities and specificities, likelihood ratios (LRs) and post-test probabilities were calculated to quantify aEEG utility to diagnose seizures in three typical clinical scenarios.<\/jats:p><jats:p>\n            Results\u2003Prevalence data supported pretest probabilities for neonatal seizures of 0.4 in neonatal hypoxic ischemic encephalopathy (HIE), 0.27 in bacterial meningitis, and 0.05 in extreme prematurity. Reported sensitivity of 85% and specificity of 90% for seizures with expert aEEG interpretation yielded a positive likelihood ratio (LR+) of 8.7 and a negative likelihood ratio (LR\u2212) of 0.17. Reported sensitivity of 65% and specificity of 70% with intermediate interpretation yielded LR+ 2.17 and LR\u2212 0.5. Reported sensitivity of 40% and sensitivity of 50% with inexperienced interpretation gave LR+ 0.8 and LR\u2212 1.2. These translate the ability to move pretest to post-test probability highly dependent on user expertise. For HIE, a pretest probability of seizure of 0.4 moves to a post-test probability of 0.85 when aEEG is positive for seizures by expert interpretation, and down to 0.1 when aEEG is negative. In contrast, no useful information was gained between pretest and post-test probability by aEEG interpreted as negative or positive for seizure at the inexperienced user level. Similarly, in the models of meningitis or extreme prematurity, incremental information gained from aEEG ranged widely based on interpreter experience.<\/jats:p><jats:p>\n            Conclusion\u2003aEEG is most useful to screen for neonatal seizures when used in conditions with high seizure prevalence, and when interpretation has a sensitivity and specificity as reported for expert users. In contrast, aEEG can become negligible in providing meaningful clinical information when applied in conditions having lower seizure prevalence or when interpretation has low accuracy. Appropriate patient selection and high quality interpretation are essential for aEEG utility in neonatal seizure detection.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0040-1721711","type":"journal-article","created":{"date-parts":[[2020,12,15]],"date-time":"2020-12-15T23:44:10Z","timestamp":1608075850000},"page":"1132-1137","source":"Crossref","is-referenced-by-count":15,"title":["How Helpful Is aEEG? Context and User Experience Matter"],"prefix":"10.1055","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0813-1334","authenticated-orcid":false,"given":"Amanda G.","family":"Sandoval Karamian","sequence":"additional","affiliation":[{"name":"Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney J.","family":"Wusthoff","sequence":"additional","affiliation":[{"name":"Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania"},{"name":"Division of Child Neurology and Division of Pediatrics\u2014Neonatal and Developmental Medicine, Stanford University, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,12,15]]},"reference":[{"issue":"10","key":"ref1","doi-asserted-by":"crossref","first-page":"1342","DOI":"10.1177\/0883073813488663","article-title":"Amplitude-integrated electro-encephalography: the child neurologist's perspective","volume":"28","author":"H C Glass","year":"2013","journal-title":"J Child Neurol"},{"issue":"03","key":"ref2","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/j.siny.2018.02.003","article-title":"Amplitude-integrated electroencephalography for seizure detection in newborn infants","volume":"23","author":"L Hellstr\u00f6m-Westas","year":"2018","journal-title":"Semin Fetal Neonatal Med"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1038\/jp.2008.195","article-title":"Limitations of single-channel EEG on the forehead for neonatal seizure detection","volume":"29","author":"C J Wusthoff","year":"2009","journal-title":"J Perinatol"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.jpeds.2016.03.035","article-title":"Contemporary profile of seizures in neonates: a prospective cohort study","volume":"174","author":"H C Glass","year":"2016","journal-title":"J Pediatr"},{"issue":"03","key":"ref5","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1097\/INF.0b013e3181fab1e7","article-title":"Neonatal bacterial meningitis: 444 cases in 7 years","volume":"30","author":"J Gaschignard","year":"2011","journal-title":"Pediatr Infect Dis J"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1016\/B978-0-444-52910-7.00030-1","article-title":"Neonatal bacterial meningitis","volume":"112","author":"O Baud","year":"2013","journal-title":"Handb Clin Neurol"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.jpeds.2017.03.004","article-title":"Electrographic seizures during the early postnatal period in preterm infants","volume":"187","author":"R O Lloyd","year":"2017","journal-title":"J Pediatr"},{"issue":"01","key":"ref8","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1542\/peds.91.1.128","article-title":"Electrographic seizures in preterm and full-term neonates: clinical correlates, associated brain lesions, and risk for neurologic sequelae","volume":"91","author":"M S Scher","year":"1993","journal-title":"Pediatrics"},{"issue":"02","key":"ref9","doi-asserted-by":"crossref","first-page":"F106","DOI":"10.1136\/adc.2010.204735","article-title":"Prognostic value of EEG in very premature newborns","volume":"97","author":"A Le Bihannic","year":"2012","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"06","key":"ref10","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1016\/j.clinph.2010.09.028","article-title":"Neonatal seizure recognition\u2014comparative study of continuous-amplitude integrated EEG versus short conventional EEG recordings","volume":"122","author":"N Frenkel","year":"2011","journal-title":"Clin Neurophysiol"},{"issue":"06","key":"ref11","doi-asserted-by":"crossref","first-page":"835","DOI":"10.1016\/j.jpeds.2009.01.002","article-title":"A pilot study of continuous limited-channel aEEG in term infants with encephalopathy","volume":"154","author":"R Lawrence","year":"2009","journal-title":"J Pediatr"},{"issue":"06","key":"ref12","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1542\/peds.2007-1839","article-title":"Accuracy of bedside electroencephalographic monitoring in comparison with simultaneous continuous conventional electroencephalography for seizure detection in term infants","volume":"121","author":"D K Shah","year":"2008","journal-title":"Pediatrics"},{"issue":"04","key":"ref13","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s12264-011-1413-x","article-title":"Diagnostic value of amplitude-integrated electroencephalogram in neonatal seizures","volume":"27","author":"L Zhang","year":"2011","journal-title":"Neurosci Bull"},{"issue":"01","key":"ref14","doi-asserted-by":"crossref","first-page":"F37","DOI":"10.1136\/fn.89.1.F37","article-title":"Non-expert use of the cerebral function monitor for neonatal seizure detection","volume":"89","author":"J M Rennie","year":"2004","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"issue":"04","key":"ref15","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1542\/peds.2007-0514","article-title":"Sensitivity of amplitude-integrated electroencephalography for neonatal seizure detection","volume":"120","author":"R A Shellhaas","year":"2007","journal-title":"Pediatrics"}],"container-title":["American Journal of 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