Heart Rate Variability in Children Receiving Palliative Care: An Exploratory Cross-Sectional Study

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Children receiving palliative care (n=58). Intervention: Palliative care hospitalization vs. Age- and gender-matched healthy children. Primary outcome: Standard deviation of NN intervals (SDNN) in milliseconds (p=0.0001).

Q: What does this research mean for the field?

Hospitalized pediatric palliative care patients exhibit significantly lower heart rate variability across time and frequency domains compared to healthy children. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Meryem Beyazal; Ganime Ayar

doi:10.4274/jpr.galenos.2026.66664

September 1, 2026The Journal of Pediatric ResearchOpen Access

Heart Rate Variability in Children Receiving Palliative Care: An Exploratory Cross-Sectional Study

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Key result

Pediatric palliative care patients show ~53% lower heart rate variability than healthy controls.

P=0.0001
n=58

Why the study?

Heart rate variability parameters in children hospitalized in palliative care have not been well characterized.

Do heart rate variability parameters differ in pediatric patients receiving palliative care compared to healthy controls?

Key Points

To evaluate heart rate variability parameters in hospitalized pediatric palliative care patients compared with healthy controls.
Cross-sectional study evaluating 28 hospitalized pediatric palliative care patients (mean age 9.04±6.02 years) and 30 age- and gender-matched healthy controls (mean age 9.10±4.03 years).
Continuous 24-hour Holter monitoring was used to record and compare electrocardiographic characteristics and time- and frequency-domain heart rate variability parameters.
Palliative care patients demonstrated significantly higher mean heart rate (107.2±21.6 vs 90.4±10.9 bpm, p=0.001), lower maximum heart rate (156.3±21.9 vs 165.9±21.8 bpm, p=0.049), and shorter PR duration (120 vs 140 ms, p=0.049) compared to controls.
All time- and frequency-domain heart rate variability parameters were significantly lower in palliative patients, including median SDNN (73.5 vs 155.0 msec, p=0.0001), rMSSD (27.5 vs 73.5 msec, p=0.0001), and total power (896.9 vs 3,138.0 msec2, p=0.0001).
Subgroup analysis of palliative patients revealed higher median rMSSD in patients with tracheostomy (32 vs 20, p=0.044) and lower median rMSSD in patients with gastrostomy (14 vs 29, p=0.037).

Study Design

Type

Cross-Sectional (n=58)

Multicenter

No

Structured PICO

Do heart rate variability parameters differ in pediatric patients receiving palliative care compared to healthy controls?

P

Population

58 children (mean age ~9 years, 51.7% female), comprising 28 pediatric palliative care patients hospitalized for at least two weeks and 30 matched healthy controls, who underwent 24-hour Holter monitoring.

E

Exposure

Hospitalization in a pediatric palliative care clinic

C

Comparator

Age- and gender-matched healthy control participants

O

Outcome

Heart rate variability (HRV) time and frequency domain parameters, and minimum, maximum, and mean heart rates, measured via 24-hour Holter monitoringsurrogate

Main Result

Absolute Event Rate: 73.5% vs 155%

p-value: p=0.0001

Pediatric palliative care patients exhibit significantly reduced heart rate variability and higher mean heart rates compared to healthy controls, indicating altered autonomic regulation.

Limitations

Single-center study with a relatively small sample size.
Heterogeneity of underlying diagnoses in the palliative care population.
Lack of disease-specific subgroup analyses.
Emotional and psychological factors like anxiety and sleep quality were not systematically assessed.
Cross-sectional design precludes conclusions about causality or longitudinal changes.
Selection of control participants due to family history may have introduced potential selection bias.
Single center with a relatively small sample size
Heterogeneity of the underlying diagnoses in the palliative care population
Lack of disease-specific subgroup analyses
Emotional and psychological factors such as anxiety, pain perception, and sleep quality were not systematically assessed or controlled for
Cross-sectional design precludes causal inferences or assessing changes over time
Potential selection bias in control participants who underwent Holter monitoring due to family history

Implication

Lower HRV may indicate autonomic dysregulation in palliative care children; hypothesis-generating and should not yet change practice.

Abstract

Aim: Heart rate (HR) variability (HRV) is simply a measure of the variation in time between each heartbeat.This variation is controlled by the autonomic nervous system.The aim of this study was to evaluate HRV parameters in children who were hospitalized in palliative care.Materials and Methods: Twenty-eight palliative patients and 30 age-and gender-matched healthy control participants were included in this study.24-hour Holter monitoring results were compared.Results: The minimum and mean HRs were significantly higher, while the maximum HR was significantly lower in the palliative-care patients.Additionally, PR duration was shorter in the palliative care patients than in the control participants.Moreover, all time and frequency domain HRV values were lower in the palliative-care patients compared to the control participants.Lastly, the low frequency/high frequency ratio was almost significantly higher in the palliative care patients than in the controls.In the analysis of only palliative cases, the mean root mean square of successive RR interval differences and the percentage of successive RR intervals which differed by more than 50 ms (pNN50) were significantly higher in those patients with tracheostomy, while the same parameters were significantly lower in those with gastrostomy.Conclusion: HRV parameters may provide complementary information regarding autonomic regulation in pediatric palliative care settings.

Discussion

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Cite This Study

Beyazal et al. (2026) conducted a cross-sectional in Children receiving palliative care (n=58). Palliative care hospitalization vs. Age- and gender-matched healthy children was evaluated on Standard deviation of NN intervals (SDNN) in milliseconds (p=0.0001). Children receiving palliative care demonstrated significantly lower heart rate variability, including a median SDNN of 73.5 ms compared to 155.0 ms in healthy controls.

synapsesocial.com/papers/6ad0fce415427f6a84040378 https://doi.org/10.4274/jpr.galenos.2026.66664

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Heart Rate Variability in Children Receiving Palliative Care: An Exploratory Cross-Sectional Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Heart Rate Variability in Children Receiving Palliative Care: An Exploratory Cross-Sectional Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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