Feasibility of wearable monitors to detect heart rate variability in children with hand, foot and mouth disease

Abstract

Hand foot and mouth disease (HFMD) is caused by a variety of enteroviruses, and occurs in large outbreaks in which a small proportion of children deteriorate rapidly with cardiopulmonary failure. Determining which children are likely to deteriorate is difficult and health systems may become overloaded during outbreaks as many children require hospitalization for monitoring. Heart rate variability (HRV) may help distinguish those with more severe diseases but requires simple scalable methods to collect ECG data.We carried out a prospective observational study to examine the feasibility of using wearable devices to measure HRV in 142 children admitted with HFMD at a children's hospital in Vietnam. ECG data were collected in all children. HRV indices calculated were lower in those with enterovirus A71 associated HFMD compared to those with other viral pathogens.HRV analysis collected from wearable devices is feasible in a low and middle income country (LMIC) and may help classify disease severity in HFMD.

Keywords: Hand foot and mouth disease; Heart rate variability; Vietnam; Wearable devices.

Fig. 1

HRV indices according to both disease severity and pathogen. Figure shows HRV indices according to pathogen (EVA-71 red, other viruses green) and severity of disease. Mild (2a), Severe (2b1), very severe (2b2, 3 & 4). Panels: left Total power (ms.²); right Standard deviation of NN intervals -SDNN (ms)

Fig. 2

Distribution of HRV indices reflecting the general activity of ANS by pathogens in different severities. Figure shows HRV indices according to pathogen (EVA-71 red, other viruses green) and severity of disease. Mild (Grade 2a), Severe (Grades 2b1& 2b2) very severe (Grades 3 & 4). Panels above-below from left to right: High Frequency (HF) (ms²); High frequency normalized units (HFnu) (%); Low Frequency (LF) (ms.²); Low Frequency normalized units (LFnu) (%); SD1 (ms); SD1 normalizised units (%); SD2 (%); SD2 (ms); SD2 normalized units (%)