Grading hypoxic-ischemic encephalopathy in neonatal EEG with convolutional neural networks and quadratic time-frequency distributions.

To develop an automated system to classify the severity of hypoxic-ischaemic encephalopathy injury (HIE) in neonates from the background electroencephalogram (EEG).. By combining a quadratic time-frequency distribution (TFD) with a convolutional neural network, we develop a system that classifies 4 EEG grades of HIE. The network learns directly from the two-dimensional TFD through 3 independent layers with convolution in the time, frequency, and time-frequency directions. Computationally efficient algorithms make it feasible to transform each 5 min epoch to the time-frequency domain by controlling for oversampling to reduce both computation and computer memory. The system is developed on EEG recordings from 54 neonates. Then the system is validated on a large unseen dataset of 338 h of EEG recordings from 91 neonates obtained across multiple international centres.The proposed EEG HIE-grading system achieves a leave-one-subject-out testing accuracy of 88.9% and kappa of 0.84 on the development dataset. Accuracy for the large unseen test dataset is 69.5% (95% confidence interval, CI: 65.3%-73.6%) and kappa of 0.54, which is a significant (P<0.001) improvement over a state-of-the-art feature-based method with an accuracy of 56.8% (95% CI: 51.4%-61.7%) and kappa of 0.39. Performance of the proposed system was unaffected when the number of channels in testing was reduced from 8 to 2-accuracy for the large validation dataset remained at 69.5% (95% CI: 65.5%-74.0%).The proposed system outperforms the state-of-the-art machine learning algorithms for EEG grade classification on a large multi-centre unseen dataset, indicating the potential to assist clinical decision making for neonates with HIE.