Comparison of Cranial Ultrasound and Amplitude‐Integrated Electroencephalography in Predicting Neurodevelopmental Outcomes in Neonates With Hypoxic–Ischemic Encephalopathy: A Systematic Review and Meta‐Analysis

Background Hypoxic–ischemic encephalopathy (HIE) remains a leading cause of neonatal mortality and long‐term neurodevelopmental impairment. Methods PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to the latest update for observational studies evaluating the prognostic value of aEEG and/or cUS in term and near‐term neonates with HIE. The primary outcome was adverse neurodevelopmental outcome, and the secondary outcome was cerebral palsy (CP). Random‐effects models were applied to estimate pooled proportions and diagnostic performance metrics. Heterogeneity was assessed using the I 2 statistic, with meta‐regression and sensitivity analyses conducted to explore potential sources of heterogeneity and result robustness. Results Ten studies involving 901 neonates with HIE were included. The pooled proportion of adverse neurodevelopmental outcomes (NDO) was 0.44 (95% CI: 0.34–0.54; I 2 = 84.0%). Subgroup analyses demonstrated similar adverse outcome proportions for aEEG (0.43), cUS (0.42), and conventional EEG‐based patterns (0.50), with no significant between‐group differences. For aEEG, the pooled diagnostic odds ratio for predicting adverse NDO was 18.85 (95% CI: 7.31–48.65). The pooled incidence of CP was 0.02 (95% CI: 0.01–0.07), with low to moderate heterogeneity. Meta‐regression did not identify publication year or assessment timing as significant contributors to heterogeneity, and sensitivity analyses confirmed result stability. Conclusions Adverse NDO remain frequent in neonates with HIE. aEEG demonstrates strong prognostic value for early prediction of unfavorable NDO, while cUS provides complementary but less definitive prognostic information. Standardized assessment protocols and outcome definitions are required to improve neuroprognostication in neonatal HIE.