Neonatal seizure detection using multichannel display of envelope trend

We aimed to determine whether analysis of EEG envelope trend aids bedside detection of neonatal seizures. Five neonatal EEGs with multiple seizures were used to determine optimal trend parameters for seizure detection. Using these parameters, envelope trends were generated on eight additional EEGs, evaluated by experienced and inexperienced users, and compared to traditional EEG interpretation. Seizures were best detected using envelope trend of 2-6 Hz activity over 20-s epochs. Experienced and inexperienced users identified 88% and 55% of prolonged seizures, respectively, 40% and 6% of brief seizures, and 20% and 0% of slowly evolving seizures. All users identified less than two false positives per hour. Thus, an experienced envelope trend user accurately identified longer seizures but did not identify brief or slowly evolving seizures. Less experienced users were less accurate. Trending may be a useful tool for seizure detection in some neonates.