Background: Amplitude-integrated electroencephalography (aEEG) is a neurophysiology tool used at the bedside to show the trend of brain activity. Objectives: To evaluate the diagnostic and prognostic significance of aEEG neuromonitoring in al Hussein hospital PICU. Cairo, Egypt, and its usefulness in detecting seizures to aid in improved management and identification of unnecessary indications. Methods: This prospective observational study was carried out on 48 children aged from two months to 14 years of both sexes. The research took place from January 2022 to September 2023 .following approval from the Ethical Committee of Al Azhar University Hospitals. All patients  with one or more of the following disorders,(encephalopathy. traumatic brain injury, poisoning, sepsis, post rescusitation, suffocation, post brain surgery, post ictel state and abnormal movements) were subjected to full history taking &complete clinical evaluation followed by lab..& radiological & C.T. exam. if indicated &then put into  continuous aEEG monitoring. Lastly the studied patient were classified into two sub groups ; A-    favorable aEEG which include Continuous normal voltage (CNV), discontinuous normal voltage (DC) B-    unfavorable aEEG which include continuous low voltage (CLV), burst suppression (BS), and flat trace (FT) Results: The mean Glasgow Coma Scale significantly improved among children with subclinical seizure after treatment (P=0.006).  Children with unfavorable aEEG showed significantly higher mortality, prolonged hospital stay, and multiple anti-epileptic drugs (AED) (P<0.05) compared to favorable aEEG. There was insignificant difference between children with or without favorable aEEG regarding the causes of admission. Severe disability, death  were significantly higher among children with unfavorable aEEG (P<0.05) Conclusion: Implementing early aEEG monitoring can assist intensive care unit (ICU) providers in directing clinical care and confirmation of suspected seizure and detection of non-convulsive seizure and therapy guidance. Children with favorable aEEG associated with lower mortality rate, median days of hospital stay, less days on MV ,  need less anti-epileptic drug and less motor sequel on discharge  compared to unfavorable aEEG.