Professor of Neurology Courtney Wusthoff leads efforts to advance care for newborns with neurological challenges, like seizures and brain injury. This year, she will also lead the American Clinical Neurophysiology Society (ACNS) as its new president.

Wusthoff, chief of child neurology at UC Davis Health, was instrumental in developing the 2025 ACNS guideline on indications for continuous electroencephalogram (EEG) in neonates. The document provides guidance for monitoring seizures in newborns. She also coauthored the American Academy of Pediatrics’ latest guidance on using therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy (HIE) — a cooling technique to protect newborn brains.

In this Q&A, Wusthoff shares the best practices in treating newborns with potential HIE or suspected seizures.

What is HIE and why is it a major concern in neonatal neurology?

HIE is a brain injury caused by interrupted blood or oxygen flow around birth. It’s often unexpected and can occur even in healthy pregnancies. Babies with HIE may need resuscitation and show abnormal neurological signs after birth. Immediate intervention is critical because the first hours after birth shape long-term outcomes.

How do you treat babies with suspected HIE?

When we suspect HIE, we use therapeutic hypothermia — cooling the baby to 34 degrees Celsius (93.2 degrees Fahrenheit) for 72 hours within six hours of birth. After cooling, we initiate rewarming at 0.5 degrees Celsius an hour. This slows brain injury and improves survival and developmental outcomes.

At UC Davis, we pair cooling with continuous EEG monitoring, which records the newborn's brain activity using electrodes placed on the scalp. This monitoring detects seizures, which are uncontrolled brain activity.

Why is EEG monitoring important?

About one-third of babies with HIE experience seizures, so this monitoring is essential. Most seizures are invisible without EEG. Early diagnosis allows us to treat babies to help stop seizures.

Cooling and EEG monitoring complement each other. The cooling protects the brain by trying to reduce additional or worsening injury. Monitoring allows diagnosis and early treatment of seizures, preventing further harm.

Is this EEG monitoring a standard practice at UC Davis Health for newborns?

Yes, it is. Nationwide, cooling for suspected HIE is standard practice, but not every children's hospital or Neonatal Intensive Care Unit (NICU) has been offering continuous EEG monitoring to diagnose seizures. It's exciting to be able to provide that highest level of care for our patients.

The American Academy of Pediatrics published a new clinical report on therapeutic hypothermia. What is the main takeaway?

The new AAP clinical report offers guidance for clinicians about what they need to consider when treating babies using therapeutic hypothermia. This includes continuous EEG monitoring to help accurately diagnose seizures.

It is in line with the International League Against Epilepsy’s recommendation of continuous EEG monitoring as the gold standard anytime you suspect neonatal seizures. The American Clinical Neurophysiology Society also issued its guideline that tells which babies are at a higher risk for seizures and might need EEG monitoring.

In what ways have diagnosing and treating seizures in neonates changed?

Neonatal neurology is a rapidly changing field. We're learning more each year how to take better care of newborn babies.

We still need better treatments for seizures when they happen. We have a couple of medications that we can use in newborns to stop seizures. We have learned that if you treat seizures quickly, you're often able to stop them with lower doses of medicine, which is important.

In fact, our research showed that you can often treat seizures with a short course of medicine while the baby is in the NICU and then stop it before the baby goes home. So that's been a big recent change in practice. It used to be that babies would go home, and they would continue taking anti-seizure medicine, sometimes for years. But we've learned that most newborns don't need that. Once you get the seizures under control in the NICU, you might be able to stop that medicine before they go home and they don't have to keep taking it.

How is UC Davis expanding neonatal neurology?

Our goal is to support families from pregnancy through infancy and beyond, ensuring the best possible outcomes. We are working closely with the UC Davis Fetal Care and Treatment Center to provide prenatal consultations when there is concern for a neurologic problem in a fetus. We also continue to work with our partners in the UC Davis NICU to expand our care for critically ill newborns. Developmental and Behavioral Pediatrics provides outstanding support for our NICU graduates. We also are building a dedicated neonatal neurology clinic for follow-up care after babies go home. It’s an exciting time.