Background Single-channel amplitude EEG (aEEG) is a valuable tool for evaluating neonatal encephalopathy and the identification of electrographic seizures. Some devices are able to record more channels.

Objective To compare seizure activity, background pattern and amplitude between one and two-channel aEEG recordings in newborns.

Methods The two-channel recordings (BRM2; F3–P3; F4–P4) of 34 neonates with seizures were compared with the cross-cerebral single-channel recording (BRM2; P3–P4). Each channel was reviewed separately and in random order with respect to duration and number of seizures, background pattern and amplitude.

Results In 11/13 infants with unilateral brain lesion more seizures were seen on the affected side compared with the contralateral side. In all infants with unilateral lesions seizures were detected on the cross-cerebral recording, in 4/13 infants more seizures were seen on the cross-cerebral recording compared with the two channels. In 10/19 infants with diffuse brain damage and in 1/2 infants without brain damage there was no difference in seizure detection between one and two-channel recordings. An abnormal background pattern and amplitude on the affected side compared with the contralateral side and the cross-cerebral recording was only seen in 1/13 infants. In 6/13 infants recordings from the two channels showed an abnormal background pattern and amplitude, whereas the cross-cerebral recording was normal.

Conclusion In most infants with a unilateral brain lesion, the two-channel aEEG recording showed increased seizure detection in the affected hemisphere. In none of these infants was seizure activity missed with one-channel recording. In infants with diffuse brain damage seizures were detected in both one and two-channel recordings.