At this year’s Child Neurology Society Annual Meeting, a major seminar brought together leading experts, including patient advocacy, to talk about the importance of better screening for neonatal seizures, including the use of Continuous EEG (cEEG). Better screening ensures more information is known about a newborn's neurological status, which often leads to different treatment paths, and even the confirmation of appropriate diagnoses, like HIE.
Neonatal Hypoxic Ischemic Encephalopathy (HIE) is the leading cause of neonatal seizures, and the whether a baby is having seizures or not is important to finding out 1) the cause and 2) any treatment for the underlying cause and treatment, like qualifying for therapeutic hypothermia for moderate to severe HIE.
The session at CNS 2025, titled “Evidence-Based Guidelines for Continuous EEG in the Neonate,” focused on how updated research, technology, and family engagement are transforming how hospitals detect and manage seizures and brain injury in newborns.
Organized by Dr. Adam Numis, a pediatric epileptologist of the University of California–San Francisco, who also serves as a co-author of the new ACNS (American Clinical Neurophysiology Society) guideline on neonatal cEEG and on Hope for HIE's Medical Advisory Board, the seminar included the following people:
This seminar reflected a turning point in how medicine and families collaborate to improve newborn brain care. Here are some of the most important takeaways for both clinicians and families:
| Question | What We Learned |
|---|---|
| When is cEEG most useful? | It’s most valuable when seizure activity is suspected, or when a baby has conditions like HIE or stroke that carry high seizure risk. |
| Is aEEG enough? | aEEG is helpful in many settings, but cEEG provides far more detail and accuracy — especially for subtle or non-visible seizures. |
| What else can EEG show? | EEG patterns can help assess how the brain is healing or adapting, and can even inform follow-up and developmental care plans. |
| Why involve families? | Families bring context, insight, and accountability — ensuring guidelines reflect not just “what’s possible,” but “what matters.” |
| What’s next for babies with mild HIE? | Studies like COOL PRIME are beginning to include cEEG for babies with mild symptoms, helping close the gap between early detection and long-term outcomes. |
When a baby is in the NICU after HIE or another cause of neonatal encephalopathy, you may hear the care team use terms like clinical seizures, subclinical seizures, or acute provoked seizures, and types of EEG like cEEG and aEEG. These words describe how seizures appear, how they’re detected, and what causes them. Here’s what they mean in plain language:
These are seizures that can be seen at the bedside.
You might notice:
Even though they are visible, newborn seizures often look subtle — and not every movement is a true seizure. That’s why EEG monitoring is so important to confirm what’s happening in the brain.
These seizures do not have visible signs — the baby looks calm or asleep — but the brain’s electrical signals show seizure activity.
They can only be found using EEG (electroencephalogram) monitoring, which records brain waves.
Subclinical seizures are very common in babies with HIE, especially during the first days of life. Because they can go unnoticed without EEG, continuous monitoring helps doctors recognize and treat them early to protect the brain.
These seizures happen as a direct response to an immediate cause, such as:
They occur in the newborn period, right after the injury or problem happens. These are different from epilepsy, which involves repeated seizures over time.
Developing Epilepsy: Some babies with acute provoked seizures from HIE do and some do not develop lifelong epilepsy, but careful follow-up helps monitor long-term outcomes. More long-term data is needed to collect the full incidence of babies who go onto develop epilepsy outside of early childhood.
Because newborn seizures can be invisible or brief, EEG monitoring helps doctors “see” what’s happening inside the brain. There are two main types used in NICUs:
However, aEEG doesn’t show the full detail of what’s happening. Some seizures — especially short or subtle ones — may not appear clearly.
While cEEG requires more equipment and staff, it provides a much clearer, more complete picture of the baby’s brain function.
| Feature | aEEG (Amplitude-Integrated) | cEEG (Continuous) |
|---|---|---|
| Number of electrodes | 2–4 | 8–20+ |
| Level of detail | Basic overview / trends | Full, detailed brain-wave recording |
| Who interprets it | Usually neonatologist | Pediatric neurologist |
| Seizure detection | Can miss subtle or brief seizures | Detects almost all seizures (clinical and subclinical) |
| Availability | Easier, faster to start | Requires more resources and expertise |
| Main purpose | Screening and general monitoring | Diagnosis, treatment guidance, and prognosis |
Including family voices in these discussions ensures care is not just clinically sound, but compassionate and clear.
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While a recording is not yet available of the presentation, here is a copy of the slides:
Hope for HIE is a proud organizational partner of the Neonatal Seizure Registry workgroup.
The NSR website has comprehensive resources for families, providers, and researchers.
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