EEG for the Diagnosis of Neonatal Seizures in the Asia–Oceania Region: An International Survey Across 19 Countries by the ILAE-Young Epilepsy Section Pediatric Epilepsy Study Group

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Objective: To evaluate the availability and utilization of electroencephalography (EEG), clinician perspectives on neonatal seizure diagnosis, among neonatologists and neurologists across the International League Against Epilepsy (ILAE) Asia–Oceania region. Methods: An online cross-sectional survey was conducted by the ILAE-Young Epilepsy Section Pediatric Epilepsy study group of Asia Oceania from November 2024 to December 2025, among neonatologists and neurologists involved in neonatal seizure care at neonatal intensive care unit (NICU)-capable centers across Asia Oceanian countries. Data were analyzed for EEG availability, access, utilization, clinical practice, guideline awareness, and implementation barriers. Results: A total of 453 responses were received (English, n = 415; Chinese, n = 38), including 240 neurologists and 213 neonatologists. Nineteen responses (4%) were excluded, leaving 434 for analysis. EEG availability remained limited, with 27% (62/226) of neurologists and 32.7% (68/208) of neonatologists reporting 24/7 access. Among EEG-capable centers, neurologists predominantly used conventional EEG (53.8%, 120/223), whereas neonatologists predominantly used amplitude-integrated EEG (39.1%, 36/92). Clinical diagnosis without EEG remained frequent, among 41.8% (87/208) of neonatologists. In-house pediatric neurologist for EEG reporting was available in 58.2% (121/208) of centers, while outsourced services accounted for 20.7% (43/208) and nonpediatric specialists or technologists for 18.8% (39/208). Limited confidence in neonatal EEG interpretation was reported by 67.3% (148/226) of neurologists, and 51.8% (114/226) reported no neonatal EEG training during residency. Neurology consultation practices were inconsistent among neonatologists, with only 32.7% (72/220) reporting routine involvement. Awareness of the ILAE neonatal seizure guidelines was 74.8% (163/218) among neonatologists; however, only 75.5% (123/163) considered them applicable. Barriers included lack of EEG-equipped NICUs (27.6%, 45/163), incomplete reading of guidelines (14.7%, 24/163), uncertainty regarding utility (10.4%, 17/163), and perceived lack of usefulness (5.5%, 9/163). Conclusion: Across the Asia–Oceania region, EEG use in neonatal seizure diagnosis remains limited and heterogeneous. Practice variability, infrastructure gaps, and limited training impede guideline implementation, underscoring the need for standardized pathways and capacity building. Publication History Article published online: 15 July 2026 © 2026. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Private Limited A-13A, Graphix Tower 1, 6th floor, Sector 62, Noida 201309, Uttar Pradesh, India

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Related topics: Neonatal and fetal brain pathology · Epilepsy research and treatment · Neuroscience and Neuropharmacology Research