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

Introduction: Electroencephalography (EEG), including both conventional EEG (cEEG) and amplitude-integrated EEG, is 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 h 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: Sixty-two studies (n = 3,929) were included. In neonates who underwent therapeutic hypothermia (TH) (34 studies, n = 2,538), 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.