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Expert-level detection of low-voltage intervals in EEG as a robust biomarker of neonatal encephalopathy

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Computer Science > Machine Learning

arXiv:2610.12680 (cs)
[Submitted on 8 Oct 2026]

Title:Expert-level detection of low-voltage intervals in EEG as a robust biomarker of neonatal encephalopathy

View a PDF of the paper titled Expert-level detection of low-voltage intervals in EEG as a robust biomarker of neonatal encephalopathy, by John M. O'Toole and 6 other authors
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Abstract:Background: Discontinuity in neonatal EEG is a critical marker of brain dysfunction but can be difficult to quantify visually. Inter-burst intervals (IBIs) are a key characteristic of discontinuity, yet their definition does not easily translate to AI detection. Objectives: To introduce low-voltage intervals (LVIs), defined exclusively by amplitude and duration, as a context-independent alternative to IBIs, develop an AI detection method for LVIs, and assess their clinical utility as a marker of brain injury. Methods: We developed a ConvNeXt model to detect LVIs and compared its performance with existing methods. We then tested the clinical relevance of detected LVIs across four applications: 1) grading background EEG abnormalities on an open benchmark dataset, 2) classifying clinical hypoxic-ischaemic encephalopathy (HIE) grades and comparing with a normal EEG dataset, 3) seizure prediction, and 4) association with seizure burden. Results: For training and validation, 654 hours of per-channel EEG from 123 neonates were reviewed and 51,162 LVIs were annotated. On held-out validation, ConvNeXt had an AUC of 0.996 and a Matthews correlation coefficient of 0.926. Model-reader agreement exceeded inter-reader agreement ($\Delta \kappa = 0.025$, 95% CI: 0.007 to 0.045, $p<0.001$), attaining expert-level equivalence. On a combined dataset of 444 neonates, percentage LVI showed a strong association with EEG grades (Spearman's $\rho=0.801$), a moderate association with HIE grades ($\rho=0.384$), a weaker association with seizure burden ($\rho=0.244$), and a strong seizure prediction capacity (AUC $=0.872$). Conclusion: AI detection of LVIs achieves expert-level equivalence, whereas quantitative features do not. Automated LVI quantification provides a robust clinical biomarker of neonatal encephalopathy associated with background EEG activity, HIE severity, and seizure risk.
Comments: 22 pages, 8 figures, and 9 tables including the appendix. Under review
Subjects: Machine Learning (cs.LG); Signal Processing (eess.SP); Medical Physics (physics.med-ph)
ACM classes: I.2.1
Cite as: arXiv:2610.12680 [cs.LG]
  (or arXiv:2610.12680v1 [cs.LG] for this version)
  https://doi.org/10.48550/arXiv.2610.12680
arXiv-issued DOI via DataCite (pending registration)

Submission history

From: John M. O'Toole [view email]
[v1] Thu, 8 Oct 2026 20:04:08 UTC (3,993 KB)
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