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  • Clinical Research Article
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Newborn brain development comparison of plateau and plain regions: insights from quantitative EEG

Pediatric Research volume 99, pages 1077–1084 (2026)Cite this article

Abstract

Background

The electrical activity of the brain is sensitive to oxygen availability. However, no studies have yet reported on the brain electrical activity of newborns in plateau and plain regions.

Methods

Neonates were admitted to the Department of Neonatology at Kunming Children’s Hospital and Fudan University Children’s Hospital, where they underwent EEG monitoring (P3/P4/F3/F4) from January 2020 to December 2022. The inclusion criteria were as follows: absence of neurological symptoms and signs, no infection during hospitalization, no abnormal waveform and obvious pseudo-error of EEG, and the corrected gestational age ≥35 weeks at EEG monitoring. A total of 136 cases were recruited, with equal representation from both the plateau group (Kunming group, KM group) and the plain group (Fudan group, FD group) at the respective institutions. Each patient had one EEG monitoring recording, each with 410 quantitative electroencephalogram (qEEG) signal features extracted. Besides, demographic information (sex, birthweight, corrected gestational age) were included in the regression analysis for the sample group. qEEG signal features were used to predict corrected gestational age by Gradient Boosting Machine in each sample group.

Results

Twenty signal features in the KM group exhibited higher values compared to those in the FD group, whereas ten signal features were lower (p < 0.05) corrected by demographic information. Higher signal features tend to occur in individuals with less corrected GA (Pearson correlation coefficient −0.32, p value = 6.63e−11). The prediction model for the plains (FD model) demonstrated a coefficient of determination (R²) of 0.72 in FD group but reduced performance R² of 0.47 in KM group. Similarly, the plateau model (KM model) showed performance R² of 0.6 in KM group but 0.37 in FD group.

Conclusion

The results indicate that brain maturity in newborns from plateau regions may lag behind that of their peers from plain regions. Therefore, the brain maturity prediction model based on qEEG needs to be re-generated for different altitudes.

Impact

  • We first explored the healthy neonatal brain development from the moderate altitude and evaluated the differences of neonatal brain development between plateau and plain areas by quantitative electroencephalogram (qEEG) signals.

  • We found the brain maturity in newborns from plateau regions may lag behind that of their peers from plain regions.

  • The brain maturity prediction model based on qEEG needs to be re-generated for different altitudes.

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Fig. 1: Comparison of the quantitative signals between the two groups.
Fig. 2: Comparison of the quantitative signals between the two groups.
Fig. 3: Comparison of qEEG quantitative signals between related to altitude and corrected gestational age.
Fig. 4: Relation of qEEG quantitative signals between altitude and corrected gestational age.
Fig. 5: Comparison of the predictive models for the corrected GA in different altitudes.

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Data availability

The data that support the findings of this study are available from the first author, upon reasonable request.

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Acknowledgements

We would like to thank all colleagues contribution for the manuscript.

Funding

This study is funded by a grant from the National Key Research and Development Program of China (No. 2024YFC2707700), Zhou Wenhao Expert Workstation in Yunnan Province (No. 2019IC052), Three-year action plan for strengthening the construction of the public health system in Shanghai (GWVI-11.2-YQ22) and 2023 Young Clinical Full-time Research Team of Shanghai Medical College, Fudan University. The funding organizations played a role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Neonatology, Children’s Hospital of Fudan University, Shanghai, China

    Xiaofen Zhao, Bi Ze, Jiaqi Li & Wenhao Zhou

  2. Department of Neonatology, Kunming Children’s Hospital, Kunming, China

    Xiaofen Zhao, Linbo Huang, Xi Tan, Mifeng Yang & Yangfang Li

  3. Department of Pediatrics, Tibet Autonomous Region People’s Hospital, Lhasa, China

    Bi Ze

  4. Center for Molecular Medicine, Pediatric Research Institute, Children’s Hospital of Fudan University, National Children’s Medical Center, Shanghai, China

    Xinran Dong & Wenhao Zhou

  5. Guangzhou Women’s and Children’s Medical Center, Guangzhou, China

    Wenhao Zhou

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  1. Xiaofen Zhao
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Contributions

Xiaofen Zhao drafted the manuscript, Bi Ze and Jiaqi Li revised the manuscript. Linbo Huang, Xi Tan, Mifeng Yang, and Yangfang Li collected data, and analyzed the data for the work. Xinran Dong analyzed and visualized the data and Wenhao Zhou designed the study and critically reviewed the manuscript.

Corresponding authors

Correspondence to Xinran Dong or Wenhao Zhou.

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The authors declare no competing interests.

Ethical approval

This study was approved by the Ethics Committee of Kunming children’s hospital (IEC-C-008-A07-V3.0). Written informed consent was obtained from the legal guardians of the neonates.

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Zhao, X., Ze, B., Li, J. et al. Newborn brain development comparison of plateau and plain regions: insights from quantitative EEG. Pediatr Res 99, 1077–1084 (2026). https://doi.org/10.1038/s41390-025-04220-9

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