Use of a portable anthropometer to assess body weight, body movement, and crying frequency in newborns: An observational study

Use of a portable anthropometer to assess body weight, body movement, and crying frequency in newborns: An observational study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Use of a portable anthropometer to assess body weight, body movement, and crying frequency in newborns: An observational study Tomoo Suzuki, Kotoko Saito, Masanori Ono, Maria Nishibukuro, Shonosuke Nara, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5392167/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Developmental support for newborns is a global public health concern. Neonatal body movements serve as key indicators of overall health, playing a pivotal role in neurodevelopment. Conventional methods of assessing newborn body movements are subjective, with limited accuracy and reliability. In this study we investigated the correlation between body weight and movements using an originally developed, portable, and battery-powered device. We also explored the relationship between the frequency of newborn cries and their body weight. Methods This observational study enrolled newborns collected from two university hospitals from August 2022 to November 2023. Movement was measured using a body movement measuring device equipped with piezoelectric sensors, a foot switch, and acceleration inputs. Body movements were represented as piezoelectric peaks. Correlation and regression analyses explored the relationships among neonatal body weight (at the time of the study), body movement, crying frequency, and crying duration. Results A positive correlation was identified between body weight and number of body movements (R 2 = 0.2884). The regression analysis revealed a linear relationship between body weight and body movements per minute, and body weight and the number of cries per hour. Crying time also increased with increasing body weight (R 2 = 0.5079). Conclusions Overall, these results indicate that the body movement measuring system allowed the non-invasive detection of neonatal body movements, establishing a robust positive correlation between body weight and the number of body movements. This method may offer an accurate and objective means to assess newborn body movements and crying frequency to identify at-risk infants who require early intervention. body weight body movement measuring system crying objective neonatal motor activity assessment Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Background Neonatal morbidity and mortality pose significant global public health challenges, and early identification of infants at high risk of adverse outcomes is critical for prompt interventions. The neonatal period is pivotal for growth and development, making the assessment of a newborns’ health status is medically necessary [ 1 , 2 ]. In particular, newborn wriggling, body movements, and the number of cries are believed to be significantly associated with the infants’ subsequent neurodevelopment and health status; however, these measurements have traditionally been subjective, and have limited accuracy and reliability. Recently, with the introduction of accelerometers, it has become possible to objectively quantify body movements; however, existing studies have primarily focused on infants, and the body movements of newborns have not been elucidated in detail. Therefore, we planned this study to develop a portable, battery-powered device to accurately and objectively evaluate the body movements and crying frequency of newborns, and develop a method to identify infants who need intervention at an early stage. In this context, the body movements of newborns serve as important indicators of their overall health status and play a pivotal role in their neurological development [ 3 ]. Previous studies have established associations between newborn body movements and clinical outcomes, including cerebral palsy and neurodevelopmental delay [ 3 , 4 ]. Similarly, body weight is a critical parameter in neonatal care, and is closely related to growth, nutrition, and morbidity [ 5 ]. While prior research has explored the relationship between body weight and other measures of newborn growth and development, such as head circumference, length, and skinfold thickness, the correlation between the objective quantification of infant body movements and birth body weight remains unclear [ 6 ]. Traditionally, methods used to measure neonatal movements, such as Dubowitz's assessment, have been subjective, with limited accuracy and reliability [ 7 , 8 ]. However, the introduction of objective measurement tools such as accelerometry has enabled the more accurate and reliable quantification of body movements [ 9 ]. In the present study, we investigated the correlation between objective quantification of body movements and weight using an originally developed, portable, and battery-powered device. To the best of our knowledge, only a few studies have examined this relationship. In addition, we explored the relationship between the frequency of newborn cries and their body weight. Although some infants naturally cry more than others during the first few months of life, the significance of newborn crying remains poorly understood. Nevertheless, excessive crying in infants is considered a potential risk factor for behavioral problems [ 10 ]. Methods Participants This study enrolled 23 infants, aged between 1 and 6 days of age, including both low- and regular-weight newborns. In total, 8 newborns from Tokyo Medical University Hospital and 15 from Kanazawa University Hospital were recruited (Fig. 1 ). The recruitment period for this study was August 18, 2022, to March 14, 2024. Newborns with complications such as severe respiratory distress or chromosomal abnormalities were excluded (Fig. 1 ). Body movement measuring device The body movement measuring device comprised piezoelectric elements and acrylic boards (Fig. 2 ). The dual piezoelectric sensors were sandwiched between two acrylic boards. We utilized the piezoelectric effect, in which a polarization voltage proportional to the pressure appears when pressure is applied to a piezoelectric ceramic material. The accuracy testing of piezoelectric body movement counts was performed on five full-term infants by recording their body movements using a piezoelectric sensor and video camera. Video images were recorded using Kinovea, a video analysis software, with each body part color-coded into Excel cells at 0.1-second intervals, while visually confirming the movements of the infant's head, right and left legs, and right and left arms when the infant was crying or intervening (medical procedures). The colors of the cells were subsequently converted into numerical values using a program that converts colors into numerical values. We confirmed that this portable anthropometer measurement of body movement counts agreed within ± 20% with quantitative comparisons of body movement counts measured using video. Procedures and analysis methods The body-movement measuring device was placed in an incubator, and the voltage signals from the dual piezoelectric sensors were recorded through an A/D interface. In addition, an acceleration censor was attached above the umbilical region of the diaper worn by the newborns, and the number of body movements was calculated in three axial directions. The body movement data were then precisely analyzed using Origin 9 software (Light Stone Co., Tokyo, Japan) for data processing and graph generation. Figure 3 A and B present the direct voltage waveform captured by the piezoelectric dual sensor. Statistical analysis Data are presented as the means and standard deviations (SD). Correlation and regression analyses explored the relationships among neonatal body weight (at the time of the study), body movement, crying frequency, and crying duration. All P-values were two-sided, and statistical significance was set at P < 0.05. All analyses were performed using SPSS version 29.0 (IBM Inc., Chicago, Illinois, USA). Ethical approval The study protocol was approved by the Ethics Committees of the Tokyo Medical University (approval number: T2022-0095) and Kanazawa University (approval number: 237). All aspects of the study were explained to the parents of the newborns, who subsequently provided written informed consent for participation. Results Participant characteristics The neonates’ weights at the time of body movement measurements are presented in Table 1; the mean body weight was 2,001.0 ± 628.1 g (average ± SD). Table 1 Demographic characteristics of the newborns Case number Gestational age (week) Birth weight (g) Age at the time of fetal movement measurement (day) All body movements (n/min) Large body movements (n/min) Limbs body movements (n/min) Slight body movements (n/min) Crying number (n/hr) One crying time (sec) Mode of delivery 1 33 3/7 2,159 3 5.350 0.404 0.609 4.337 7.611 16 Vaginal 2 35 1/7 1,542 2 3.650 0.222 0.223 3.205 2.242 14 Vaginal 3 32 4/7 1,574 3 2.977 0.291 0.276 2.386 2.610 27 Vaginal 4 34 1/7 1,564 1 3.650 0.222 0.223 3.205 3.268 9 Vaginal 5 34 3/7 1,468 3 3.108 0.184 0.294 2.630 3.718 8 C-section 6 38 1/7 3,326 2 7.274 0.993 0.831 5.449 17.667 26 Vaginal 7 39 5/7 2,804 3 5.153 0.281 0.653 4.219 15.648 20 Vaginal 8 41 3,326 2 7.996 0.657 1.408 5.932 12.523 78 Vaginal 9 38 2/7 2,890 2 7.867 0.676 1.057 6.134 16.842 41 Vaginal 10 34 5/7 1,945 2 4.458 0.576 0.573 3.309 5.537 14 C-section 11 33 2/7 1,830 3 4.483 0.506 0.617 3.359 5.231 18 Vaginal 12 36 3/7 2,536 6 5.146 0.381 0.817 3.948 11.568 16 C-section 13 39 3/7 2,866 1 4.952 0.301 0.747 3.905 7.508 35 Vaginal 14 32 6/7 1,936 2 7.154 0.276 0.466 6.412 5.408 9 Vaginal 15 38 1/7 1,724 6 11.544 0.725 1.424 9.394 17.133 22 C-section 16 34 2/7 1,444 4 3.464 0.161 0.411 2.891 4.777 14 Vaginal 17 33 1,737 1 2.983 0.162 0.254 2.567 1.186 10 Vaginal 18 33 6/7 1,433 4 3.018 0.185 0.318 2.515 4.566 12 C-section 19 33 1,949 2 4.101 0.426 0.568 3.107 4.478 20 Vaginal 20 34 4/7 1,601 1 2.679 0.210 0.305 2.164 3.019 8 Vaginal 21 37 1/7 1,700 6 6.528 0.571 0.880 5.077 6.965 47 C-section 22 31 5/7 1,658 1 3.867 0.293 0.499 3.076 5.388 13 C-section 23 31 5/7 1,756 3 3.883 0.353 0.600 2.930 5.240 9 C-section Body weight and movements A positive relationship was identified between body weight and the number of body movements and cries among the enrolled newborns. The mean body movement per day increased with increasing body weight. Figure 4A shows a positive correlation (R 2 = 0.2884) between body weight and the number of body movements per minute. Regression analysis of body weight and the number of body movements per minute yielded y = 0.0018x + 1.3865, within the 95% confidence interval for all participants. Even when the body movements were classified as large, slight, or limb movements, a correlation with body weight was observed (Fig. 4B, C, and D). Body weight and frequency of cries The number of cries per hour increased with body weight, indicating a positive correlation, as presented in Figure 5A (R 2 = 0.5706). Regression analysis of body weight and number of cries per hour yielded the equation y = 0.0061x-4.725 within the 95% confidence interval for all participants. The crying time further increased with increasing body weight. Figure 5B presents a positive correlation (R 2 = 0.5079) between these two variables. Regression analysis of body weight and crying time yielded the equation y = 0.0181x-15.011 within the 95% confidence interval for all participants. Discussion This study aimed to explore the relationship between neonatal body weight and movements using a portable piezoelectric meter. This device accurately measured the body movements of newborns weighing 1,305–3,326 g, demonstrating its high versatility. Remarkably, it could also measure the body movements of infants weighing less than 1,500g with precision, despite their low postnatal activity levels. These findings revealed a positive correlation between body weight and the number of large body movements and cries. Overall, these results may contribute to our understanding of neonatal health indicators, and provide valuable insights for the early identification and intervention of infants at risk of adverse outcomes. The positive correlation observed between body weight and the number of body movements aligns with prior research, highlighting the significance of body movements as a reflection of overall health and neurological development in newborns [11]. The increased number of body movements observed in infants with higher body weights further indicates a potential association between body weight and enhanced neurological maturation, as well as improved muscle tone and coordination. These findings further emphasize the importance of monitoring and assessing body movements as objective measures of neonatal wellbeing. In addition to body movements, we explored the correlations between body weight and frequency and duration of crying. Although the significance of newborn crying remains incompletely understood, studies on this topic have been conducted for many years as a non-invasive developmental assessment tool. It is also interesting to note the wide variety of approaches to research on crying, including the novel finding that the fundamental frequency of spontaneous crying in preterm infants is higher than that in full-term infants, and the association between poor sleep quality and increased crying [12, 13]. Overall, our study indicated a tendency for the crying frequency and one-crying time to increase with body weight, thereby supporting the notion that body weight may serve as a contributing factor to vocalization patterns in newborns. Further investigation is warranted to elucidate the underlying mechanisms and potential long-term implications of this relationship. The use of portable piezoelectric meters for the objective measurement of body movements represents a notable advancement in the field of neonatal assessment. Traditional methods, such as Dubowitz's assessment, are subjective, with limited accuracy and reliability [14]. Previous studies have also indicated that objective measurement tools, such as accelerometry, could be used to quantify body movement [15]. However, these studies focused primarily on infants wearing accelerometers on their wrists and ankles. As such, most accelerometers have limited movement, are heavy for newborns to wear on their extremities, and may detach. Our body movement measurement system further enabled the measurement of various body movements by placing an acrylic board with piezoelectric elements under the cot, and gently placing the baby on the bed. By employing a device that harnesses the piezoelectric effect to quantify body movements, we were able to achieve higher accuracy and reliability in our measurements [16]. This innovative approach may provide a more objective and standardized means of assessing neonatal health indicators, thereby facilitating the early detection of at-risk infants, and thereby enabling timely interventions. Recently, the meaning of body movements has been elucidated. According to previous reports, spontaneous whole-body movements exhibited by infants without a clear purpose could contribute to sensory-motor structuring [2]. As such, functional modules related to sensation and movement are believed to be necessary for humans to freely perform complex movements with little awareness; hence, babies may prepare for this by moving their bodies earlier. This indicates that body movements may contribute to future motor development. In certain instances, developmental disorders in children may go unnoticed until they become older, resulting in the delayed introduction of interventions that address these concerns. Therefore, we believe that the measurement of body movement in this study can contribute to early neonatal interventions. The body movement measuring system used in this study can detect neonatal body movements noninvasively, with results showing a strong positive correlation between body weight and the frequency of body movements. Further research and validation of this measurement system could further contribute to more objective assessments of neonatal body movements in clinical practice, thereby reducing observer bias. It would be interesting to compare the results with the widely used General Movements Assessment (GMA). The GMA is a reliable tool for assessing the quality of infant movements and predicting cerebral palsy in term and late-preterm infants [15]. A normal GMA at 3 months in high-risk term infants has been shown to be associated with a low risk of moderate or severe cerebral palsy [17]. Additionally, the GMA can be used to assess the neurological development of preterm infants, as it correlates with neonatal behavioral neurological assessments and cerebral magnetic resonance imaging results [17]. Therefore, if our measurement system correlates with other evaluation methods, it may also be possible to objectively evaluate development during the neonatal period, which is earlier than is possible with other evaluation methods. Although actigraphy has been studied as a tool to detect sleep in infants, several reports have suggested that the results cannot be validated for sleep/wake state discrimination in this population [18, 19]. As such, actigraphy data should be interpreted with caution, and considered in conjunction with other relevant information and measurements in research and clinical settings. Overall, research on newborn body movements has provided valuable insights into the early development of motor skills, the relationship between body movements, and other aspects of neonatal development. These findings have implications for clinical practice, early intervention, and understanding human development in the early stages of life. Extensive research has also been conducted on newborn body movements. The study of newborn body movements, also known as neonatal motor behavior, aims to understand how infants move and explore their environment, and how these movements develop over time. Researchers have used various methods, including observation, video analysis, and motion tracking, to study newborn body movements [20-22]. The findings of this study may contribute to the understanding of infant motor development, reflexes, as well as the relationship between movement and brain development. However, the diagnostic accuracy of automatic movement recognition in predicting motor dysfunction in high-risk infants remains inferior to that of the clinical GMA in terms of sensitivity and specificity [23]. Consequently, it is our duty to investigate the correlation between this measurement system and GMA in the future. Although this study provides valuable insights in the field, certain limitations should be acknowledged. First, the sample size was relatively small, comprising only 23 newborns. A larger and more diverse sample size is required to enhance the generalizability of these findings. Second, the study design was cross-sectional, thereby limiting our ability to establish a causal relationship between body weight and movement or crying frequency. Longitudinal studies encompassing multiple time points would offer a more comprehensive understanding of these associations. Third, the long-term prognosis of neonates was not clarified in the present study. Overall, this study revealed a positive correlation among the objective quantification of body movements, cries, and body weight. Our research offers a more objective and reliable method for assessing neonatal health indicators by employing a portable battery-powered device to measure body movements and cries. Examining the long-term prognosis of children who deviate from this correlation may further enable early intervention for children with poor prognosis. Conclusion Using a highly sensitive body vibration meter equipped with two advanced piezoelectric meters, we were able to successfully detect newborn body movements in a non-invasive manner. These findings underscore the significance of body movements as indicators of neonatal well-being, and further provide valuable insights for the early identification and intervention of at-risk infants. The use of objective measurement tools, such as piezoelectric meters, enhances the accuracy and reliability of neonatal assessments, thereby paving the way for improved clinical practices and interventions. Further research is required to deepen our understanding of the intricate relationships among body weight, body movement, crying frequency, and neonatal health outcomes, ultimately contributing to enhanced neonatal care and improved long-term developmental trajectories. Declarations Ethics approval and consent to participate This study was conducted in accordance with the Declaration of Helsinki. The study protocol was approved by the Ethics Committees of the Tokyo Medical University (approval number: T2022-0095) and Kanazawa University (approval number: 237). All aspects of the study were explained to the parents of the newborns who provided written informed consent. Consent for publication Written informed consents were obtained from the patients to publish the article and any accompanying images, figures, and clinical details. Availability of data and material Data is provided within the manuscript. Competing interests We declare that we have no competing interests. Funding This study was supported by JSPS KAKENHI (grant number: JP20H04003) Authors' contributions TS, KS, MO, MN, SN, YS, GY, KO, KY, TN, YS, JK, NK, HN, and KS: Substantial contributions to the conception and design, acquisition of data, and analysis and interpretation of data. KS: Funding acquisition; Investigation; Methodology; Project administration. TS, KS, MO, TN, and KS drafted the article or revised it critically for important intellectual content. All authors read and approved the final manuscript. Acknowledgements We express our sincere gratitude to the newborn infants and their parents who participated in the study. References Choi H, Nho JH, Yi N, Park S, Kang B, Jang H: Maternal, infant, and perinatal mortality statistics and trends in Korea between 2018 and 2020 . Korean J Women Health Nurs 2022, 28 (4):348-357. Kanazawa H, Yamada Y, Tanaka K, Kawai M, Niwa F, Iwanaga K, Kuniyoshi Y: Open-ended movements structure sensorimotor information in early human development . Proc Natl Acad Sci U S A 2023, 120 (1):e2209953120. Einspieler C, Bos AF, Libertus ME, Marschik PB: The General Movement Assessment Helps Us to Identify Preterm Infants at Risk for Cognitive Dysfunction . Front Psychol 2016, 7 :406. Hadders-Algra M: General movements: A window for early identification of children at high risk for developmental disorders . J Pediatr 2004, 145 (2 Suppl):S12-18. McIntire DD, Bloom SL, Casey BM, Leveno KJ: Birth weight in relation to morbidity and mortality among newborn infants . N Engl J Med 1999, 340 (16):1234-1238. Pomeroy E, Stock JT, Cole TJ, O'Callaghan M, Wells JC: Relationships between neonatal weight, limb lengths, skinfold thicknesses, body breadths and circumferences in an Australian cohort . PLoS One 2014, 9 (8):e105108. Molteno C, Grosz P, Wallace P, Jones M: Neurological examination of the preterm and full-term infant at risk for developmental disabilities using the Dubowitz Neurological Assessment . Early Hum Dev 1995, 41 (3):167-176. Einspieler C, Prechtl HF: Prechtl's assessment of general movements: a diagnostic tool for the functional assessment of the young nervous system . Ment Retard Dev Disabil Res Rev 2005, 11 (1):61-67. Ricardo LIC, ICM DAS, Martins RC, Wendt A, Goncalves H, Hallal PRC, Wehrmeister FC: Protocol for Objective Measurement of Infants' Physical Activity using Accelerometry . Med Sci Sports Exerc 2018, 50 (5):1084-1092. Zeevenhooven J, de Bruin FE, Schappin R, Vlieger AM, van der Lee JH, Haverman L, van Sleuwen BE, L'Hoir MP, Benninga MA: Follow-up of infants with colic into childhood: Do they develop behavioural problems? J Paediatr Child Health 2022, 58 (11):2076-2083. Einspieler C, Prechtl HF, Ferrari F, Cioni G, Bos AF: The qualitative assessment of general movements in preterm, term and young infants--review of the methodology . Early Hum Dev 1997, 50 (1):47-60. Shinya Y, Kawai M, Niwa F, Myowa-Yamakoshi M: Preterm birth is associated with an increased fundamental frequency of spontaneous crying in human infants at term-equivalent age . Biol Lett 2014, 10 (8). Shinohara H, Kodama H: Relationship between duration of crying/fussy behavior and actigraphic sleep measures in early infancy . Early Hum Dev 2012, 88 (11):847-852. Dubowitz LM, Dubowitz V, Goldberg C: Clinical assessment of gestational age in the newborn infant . J Pediatr 1970, 77 (1):1-10. Bultmann CS, Orlikowsky T, Hausler M, Trepels-Kottek S, Disselhorst-Klug C, Schoberer M: Spontaneous movements in the first four months of life: An accelerometric study in moderate and late preterm infants . Early Hum Dev 2019, 130 :1-9. Yachi K, Nemoto T, Shimada K: Quantification of body movement measurements in low-birthweight infants . Journal of the Tsuruma Health Science Society Kanazawa University 2016, 40 (1):11-19. Zhou J, Li S, Gu L, Zhang X, Tang Z: General movement assessment is correlated with neonatal behavior neurological assessment/cerebral magnetic resonance imaging in preterm infants . Medicine (Baltimore) 2021, 100 (37):e27262. Rioualen S, Roue JM, Lefranc J, Gouillou M, Nowak E, Alavi Z, Dubourg M, Sizun J: Actigraphy is not a reliable method for measuring sleep patterns in neonates . Acta Paediatr 2015, 104 (11):e478-482. Derbin M, McKenna L, Chin D, Coffman B, Bloch-Salisbury E: Actigraphy: Metrics reveal it is not a valid tool for determining sleep in neonates . J Sleep Res 2022, 31 (1):e13444. Levy J, Hassan F, Plegue MA, Sokoloff MD, Kushwaha JS, Chervin RD, Barks JD, Shellhaas RA: Impact of hands-on care on infant sleep in the neonatal intensive care unit . Pediatr Pulmonol 2017, 52 (1):84-90. Long X, Otte R, Sanden EV, Werth J, Tan T: Video-Based Actigraphy for Monitoring Wake and Sleep in Healthy Infants: A Laboratory Study . Sensors (Basel) 2019, 19 (5). Fontana C, Ottaviani V, Veneroni C, Sforza SE, Pesenti N, Mosca F, Picciolini O, Fumagalli M, Dellaca RL: An Automated Approach for General Movement Assessment: A Pilot Study . Front Pediatr 2021, 9 :720502. Raghuram K, Orlandi S, Church P, Chau T, Uleryk E, Pechlivanoglou P, Shah V: Automated movement recognition to predict motor impairment in high-risk infants: a systematic review of diagnostic test accuracy and meta-analysis . Dev Med Child Neurol 2021, 63 (6):637-648. Additional Declarations No competing interests reported. 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University","correspondingAuthor":false,"prefix":"","firstName":"Naoaki","middleName":"","lastName":"Kuji","suffix":""},{"id":381958513,"identity":"d93a61a6-a332-48eb-b91d-c7a0960d267c","order_by":13,"name":"Hirotaka Nishi","email":"","orcid":"","institution":"Tokyo Medical University","correspondingAuthor":false,"prefix":"","firstName":"Hirotaka","middleName":"","lastName":"Nishi","suffix":""},{"id":381958514,"identity":"06c8d1e3-eee7-49ae-87f7-f3a0848f0679","order_by":14,"name":"Keiko Shimada","email":"","orcid":"","institution":"Tenshi College Graduate School","correspondingAuthor":false,"prefix":"","firstName":"Keiko","middleName":"","lastName":"Shimada","suffix":""}],"badges":[],"createdAt":"2024-11-05 04:53:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5392167/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5392167/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":70963462,"identity":"7d908bff-78d7-47ca-8618-07b46afeec39","added_by":"auto","created_at":"2024-12-09 15:49:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":795294,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of participant selection.\u003c/p\u003e\n\u003cp\u003eNewborns between 1 and 6 days of age, whose mothers provided consent, were considered eligible as candidates. Newborns with complications such as severe respiratory distress or chromosomal abnormalities were excluded. Eight newborns from Tokyo Medical University Hospital and 15 from Kanazawa University Hospital participated in this study.\u003c/p\u003e","description":"","filename":"Fig1.png","url":"https://assets-eu.researchsquare.com/files/rs-5392167/v1/1f622b0873dc8a462a24ebcf.png"},{"id":70963464,"identity":"31c4de3c-8222-4666-bf38-6110aa5df4c7","added_by":"auto","created_at":"2024-12-09 15:49:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":9297435,"visible":true,"origin":"","legend":"\u003cp\u003eOverview of the body movement measurement system. (A) The newborn body movement detection sensor utilizing dual piezoelectric elements. This device incorporated a pair of advanced dual piezoelectric sensors seamlessly integrated into a sturdy framework comprising two acrylic boards. These dual piezoelectric sensors were meticulously positioned between the acrylic boards, and firmly secured in place by screws at each corner, ensuring precise central alignment and robust stability. (B) The dual piezoelectric element design. At the heart of the system lies the double piezoelectric element, a sophisticated assembly featuring two high-performance piezoelectric elements delicately paired with a metal nut for enhanced functionality and durability.\u003c/p\u003e","description":"","filename":"Fig2.png","url":"https://assets-eu.researchsquare.com/files/rs-5392167/v1/defc600a495ed0defe0f10a4.png"},{"id":70963460,"identity":"566d6744-056b-48a2-8a9b-19213ef96ffd","added_by":"auto","created_at":"2024-12-09 15:49:07","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":2217077,"visible":true,"origin":"","legend":"\u003cp\u003eThe number of body movements recorded by the body movement measuring device and accelerometer.\u003c/p\u003e\n\u003cp\u003eIn the analysis of body movements, the body movement measuring device was deployed alongside an accelerometer. (A) Body movements are denoted by the red circles in the visual representation. (B) A green foot switch, as illustrated in the figure, serves as an indicator for situations where adult intervention is necessary. The orange markers represent the fixed acceleration values monitored at the infant's abdomen. Importantly, a robust correlation was observed in the data analysis, indicating a strong match between the piezoelectric potentials recorded by the body movement measurement system and the peak acceleration values detected by the accelerometer.\u003c/p\u003e","description":"","filename":"Fig3.png","url":"https://assets-eu.researchsquare.com/files/rs-5392167/v1/d535b5a4d75785796173e68f.png"},{"id":70963459,"identity":"cd918d6b-3701-4aeb-ab45-64d320fae200","added_by":"auto","created_at":"2024-12-09 15:49:07","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1871496,"visible":true,"origin":"","legend":"\u003cp\u003eRelationship between body weight and the number of body movements. \u003cbr\u003e\nA correlation was found between body weight and the number of body movements exhibited by the infants. Typically, infants with higher body weights displayed an increased frequency of large body movements compared with their lower body weight counterparts. (A) All body movements; (B) Large body movements; (C) Slight body movements; (D) Limb body movements.\u003c/p\u003e","description":"","filename":"Fig4.png","url":"https://assets-eu.researchsquare.com/files/rs-5392167/v1/ae0091902aac0f17b6aad101.png"},{"id":70964357,"identity":"cb29ce09-bbde-4f44-9216-1398e101c687","added_by":"auto","created_at":"2024-12-09 15:57:07","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":931450,"visible":true,"origin":"","legend":"\u003cp\u003eRelationship between body weight and the number of cries of newborns. (A) Infants with higher body weights cried more frequently than those with lower body weights. (B)\u003cstrong\u003e \u003c/strong\u003eRelationship between body weight and one crying time of newborns.\u003c/p\u003e","description":"","filename":"Fig5.png","url":"https://assets-eu.researchsquare.com/files/rs-5392167/v1/f1c0821df602c9e3e6dff010.png"},{"id":103050414,"identity":"c9d48ef1-d47d-4069-8adb-be5996bc7f7a","added_by":"auto","created_at":"2026-02-20 07:49:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":16082748,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5392167/v1/b8c44b9c-487f-427e-bada-a6fa94f55dd0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Use of a portable anthropometer to assess body weight, body movement, and crying frequency in newborns: An observational study","fulltext":[{"header":"Background","content":"\u003cp\u003eNeonatal morbidity and mortality pose significant global public health challenges, and early identification of infants at high risk of adverse outcomes is critical for prompt interventions. The neonatal period is pivotal for growth and development, making the assessment of a newborns\u0026rsquo; health status is medically necessary [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In particular, newborn wriggling, body movements, and the number of cries are believed to be significantly associated with the infants\u0026rsquo; subsequent neurodevelopment and health status; however, these measurements have traditionally been subjective, and have limited accuracy and reliability. Recently, with the introduction of accelerometers, it has become possible to objectively quantify body movements; however, existing studies have primarily focused on infants, and the body movements of newborns have not been elucidated in detail. Therefore, we planned this study to develop a portable, battery-powered device to accurately and objectively evaluate the body movements and crying frequency of newborns, and develop a method to identify infants who need intervention at an early stage. In this context, the body movements of newborns serve as important indicators of their overall health status and play a pivotal role in their neurological development [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious studies have established associations between newborn body movements and clinical outcomes, including cerebral palsy and neurodevelopmental delay [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Similarly, body weight is a critical parameter in neonatal care, and is closely related to growth, nutrition, and morbidity [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. While prior research has explored the relationship between body weight and other measures of newborn growth and development, such as head circumference, length, and skinfold thickness, the correlation between the objective quantification of infant body movements and birth body weight remains unclear [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Traditionally, methods used to measure neonatal movements, such as Dubowitz's assessment, have been subjective, with limited accuracy and reliability [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. However, the introduction of objective measurement tools such as accelerometry has enabled the more accurate and reliable quantification of body movements [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn the present study, we investigated the correlation between objective quantification of body movements and weight using an originally developed, portable, and battery-powered device. To the best of our knowledge, only a few studies have examined this relationship. In addition, we explored the relationship between the frequency of newborn cries and their body weight. Although some infants naturally cry more than others during the first few months of life, the significance of newborn crying remains poorly understood. Nevertheless, excessive crying in infants is considered a potential risk factor for behavioral problems [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThis study enrolled 23 infants, aged between 1 and 6 days of age, including both low- and regular-weight newborns. In total, 8 newborns from Tokyo Medical University Hospital and 15 from Kanazawa University Hospital were recruited (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The recruitment period for this study was August 18, 2022, to March 14, 2024. Newborns with complications such as severe respiratory distress or chromosomal abnormalities were excluded (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eBody movement measuring device\u003c/h3\u003e\n\u003cp\u003eThe body movement measuring device comprised piezoelectric elements and acrylic boards (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The dual piezoelectric sensors were sandwiched between two acrylic boards. We utilized the piezoelectric effect, in which a polarization voltage proportional to the pressure appears when pressure is applied to a piezoelectric ceramic material. The accuracy testing of piezoelectric body movement counts was performed on five full-term infants by recording their body movements using a piezoelectric sensor and video camera. Video images were recorded using Kinovea, a video analysis software, with each body part color-coded into Excel cells at 0.1-second intervals, while visually confirming the movements of the infant's head, right and left legs, and right and left arms when the infant was crying or intervening (medical procedures). The colors of the cells were subsequently converted into numerical values using a program that converts colors into numerical values. We confirmed that this portable anthropometer measurement of body movement counts agreed within \u0026plusmn;\u0026thinsp;20% with quantitative comparisons of body movement counts measured using video.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eProcedures and analysis methods\u003c/h3\u003e\n\u003cp\u003eThe body-movement measuring device was placed in an incubator, and the voltage signals from the dual piezoelectric sensors were recorded through an A/D interface. In addition, an acceleration censor was attached above the umbilical region of the diaper worn by the newborns, and the number of body movements was calculated in three axial directions. The body movement data were then precisely analyzed using Origin 9 software (Light Stone Co., Tokyo, Japan) for data processing and graph generation. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003eA and B present the direct voltage waveform captured by the piezoelectric dual sensor.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData are presented as the means and standard deviations (SD). Correlation and regression analyses explored the relationships among neonatal body weight (at the time of the study), body movement, crying frequency, and crying duration. All P-values were two-sided, and statistical significance was set at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All analyses were performed using SPSS version 29.0 (IBM Inc., Chicago, Illinois, USA).\u003c/p\u003e \u003c/div\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was approved by the Ethics Committees of the Tokyo Medical University (approval number: T2022-0095) and Kanazawa University (approval number: 237). All aspects of the study were explained to the parents of the newborns, who subsequently provided written informed consent for participation.\u003c/p\u003e"},{"header":"Results","content":"\u003ch3\u003eParticipant characteristics\u003c/h3\u003e\n\u003cp\u003eThe neonates\u0026rsquo; weights at the time of body movement measurements are presented in Table 1; the mean body weight was 2,001.0 \u0026plusmn; 628.1 g (average \u0026plusmn; SD).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1\u0026nbsp;\u003c/strong\u003eDemographic characteristics of the newborns\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003eCase\u0026nbsp;\u003cbr\u003e\u0026nbsp;number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eGestational\u0026nbsp;\u003cbr\u003e\u0026nbsp;age\u003cbr\u003e\u0026nbsp;(week)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003eBirth\u0026nbsp;\u003cbr\u003e\u0026nbsp;weight\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;(g)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003eAge at the time\u0026nbsp;\u003cbr\u003e\u0026nbsp;of fetal movement measurement\u0026nbsp;\u003cbr\u003e\u0026nbsp;(day)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eAll body\u003cbr\u003e\u0026nbsp;movements (n/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eLarge body\u003cbr\u003e\u0026nbsp;movements (n/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eLimbs body\u003cbr\u003e\u0026nbsp;movements (n/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eSlight body\u003cbr\u003e\u0026nbsp;movements (n/min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eCrying number\u003cbr\u003e\u0026nbsp;(n/hr)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eOne crying\u003cbr\u003e\u0026nbsp;time\u0026nbsp;\u003cbr\u003e\u0026nbsp;(sec)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eMode of\u0026nbsp;\u003cbr\u003e\u0026nbsp;delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e33 3/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e2,159\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e5.350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.404\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.609\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e4.337\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e7.611\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e35 1/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e1,542\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e3.650\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e3.205\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e2.242\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e32 4/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e1,574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e2.977\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e2.386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e2.610\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e34 1/7\u003c/p\u003e\n \u003c/td\u003e\n 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style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e5.932\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e12.523\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e38 2/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e2,890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e7.867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.676\u003c/p\u003e\n \u003c/td\u003e\n 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7.50799%;\"\u003e\n \u003cp\u003e2,536\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e5.146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.817\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e3.948\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e11.568\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eC-section\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e39 3/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e2,866\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e4.952\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.301\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.747\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e3.905\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e7.508\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e32 6/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e1,936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e7.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.276\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.466\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e6.412\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e5.408\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e38 1/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e1,724\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e11.544\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.725\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e1.424\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e9.394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e17.133\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eC-section\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e34 2/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e1,444\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e3.464\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.411\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e2.891\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e4.777\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e33 \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e1,737\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e2.983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.254\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e2.567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e1.186\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e33 6/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e1,433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e3.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.318\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e2.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e4.566\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eC-section\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e33 \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e1,949\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e4.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.426\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.568\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e3.107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e4.478\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e34 4/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e1,601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e2.679\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.305\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e2.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e3.019\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eVaginal\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e37 1/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e1,700\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e6.528\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.571\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e5.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e6.965\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eC-section\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e31 5/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e1,658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e3.867\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.499\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e3.076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e5.388\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eC-section\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e31 5/7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 7.50799%;\"\u003e\n \u003cp\u003e1,756\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 12.1406%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e3.883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e0.600\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e2.930\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e5.240\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 9.10543%;\"\u003e\n \u003cp\u003eC-section\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;Body weight and movements\u003c/p\u003e\n\u003cp\u003eA positive relationship was identified between body weight and the number of body movements and cries among the enrolled newborns. The mean body movement per day increased with increasing body weight. Figure 4A shows a positive correlation (R\u003csup\u003e2\u003c/sup\u003e = 0.2884) between body weight and the number of body movements per minute. Regression analysis of body weight and the number of body movements per minute yielded y = 0.0018x + 1.3865, within the 95% confidence interval for all participants. Even when the body movements were classified as large, slight, or limb movements, a correlation with body weight was observed (Fig. 4B, C, and D).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Body weight and frequency of cries\u003c/p\u003e\n\u003cp\u003eThe number of cries per hour increased with body weight, indicating a positive correlation, as presented in Figure 5A (R\u003csup\u003e2\u003c/sup\u003e = 0.5706). Regression analysis of body weight and number of cries per hour yielded the equation y = 0.0061x-4.725 within the 95% confidence interval for all participants. The crying time further increased with increasing body weight. Figure 5B presents a positive correlation (R\u003csup\u003e2\u003c/sup\u003e = 0.5079) between these two variables. Regression analysis of body weight and crying time yielded the equation y = 0.0181x-15.011 within the 95% confidence interval for all participants.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to explore the relationship between neonatal body weight and movements using a portable piezoelectric meter. This device accurately measured the body movements of newborns weighing 1,305\u0026ndash;3,326 g, demonstrating its high versatility. Remarkably, it could also measure the body movements of infants weighing less than 1,500g with precision, despite their low postnatal activity levels. These findings revealed a positive correlation between body weight and the number of large body movements and cries. Overall, these results may contribute to our understanding of neonatal health indicators, and provide valuable insights for the early identification and intervention of infants at risk of adverse outcomes. The positive correlation observed between body weight and the number of body movements aligns with prior research, highlighting the significance of body movements as a reflection of overall health and neurological development in newborns\u0026nbsp;[11]. The increased number of body movements observed in infants with higher body weights further indicates a potential association between body weight and enhanced neurological maturation, as well as improved muscle tone and coordination. These findings further emphasize the importance of monitoring and assessing body movements as objective measures of neonatal wellbeing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn addition to body movements, we explored the correlations between body weight and frequency and duration of crying. Although the significance of newborn crying remains incompletely understood, studies on this topic have been conducted for many years as a non-invasive developmental assessment tool. It is also interesting to note the wide variety of approaches to research on crying, including the novel finding that the fundamental frequency of spontaneous crying in preterm infants is higher than that in full-term infants, and the association between poor sleep quality and increased crying\u0026nbsp;[12, 13]. Overall, our study indicated a tendency for the crying frequency and one-crying time to increase with body weight, thereby supporting the notion that body weight may serve as a contributing factor to vocalization patterns in newborns. Further investigation is warranted to elucidate the underlying mechanisms and potential long-term implications of this relationship.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe use of portable piezoelectric meters for the objective measurement of body movements represents a notable advancement in the field of neonatal assessment. Traditional methods, such as Dubowitz\u0026apos;s assessment, are subjective, with limited accuracy and reliability\u0026nbsp;[14]. Previous studies have also indicated that objective measurement tools, such as accelerometry, could be used to quantify body movement\u0026nbsp;[15]. However, these studies focused primarily on infants wearing accelerometers on their wrists and ankles. As such, most accelerometers have limited movement, are heavy for newborns to wear on their extremities, and may detach. Our body movement measurement system further enabled the measurement of various body movements by placing an acrylic board with piezoelectric elements under the cot, and gently placing the baby on the bed. By employing a device that harnesses the piezoelectric effect to quantify body movements, we were able to achieve higher accuracy and reliability in our measurements\u0026nbsp;[16]. This innovative approach may provide a more objective and standardized means of assessing neonatal health indicators, thereby facilitating the early detection of at-risk infants, and thereby enabling timely interventions.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRecently, the meaning of body movements has been elucidated. According to previous reports, spontaneous whole-body movements exhibited by infants without a clear purpose could contribute to sensory-motor structuring\u0026nbsp;[2]. As such, functional modules related to sensation and movement are believed to be necessary for humans to freely perform complex movements with little awareness; hence, babies may prepare for this by moving their bodies earlier. This indicates that body movements may contribute to future motor development. In certain instances, developmental disorders in children may go unnoticed until they become older, resulting in the delayed introduction of interventions that address these concerns. Therefore, we believe that the measurement of body movement in this study can contribute to early neonatal interventions.\u003c/p\u003e\n\u003cp\u003eThe body movement measuring system used in this study can detect neonatal body movements noninvasively, with results showing a strong positive correlation between body weight and the frequency of body movements. Further research and validation of this measurement system could further contribute to more objective assessments of neonatal body movements in clinical practice, thereby reducing observer bias. It would be interesting to compare the results with the widely used General Movements Assessment (GMA). The GMA is a reliable tool for assessing the quality of infant movements and predicting cerebral palsy in term and late-preterm infants\u0026nbsp;[15]. A normal GMA at 3 months in high-risk term infants has been shown to be associated with a low risk of moderate or severe cerebral palsy\u0026nbsp;[17]. Additionally, the GMA can be used to assess the neurological development of preterm infants, as it correlates with neonatal behavioral neurological assessments and cerebral magnetic resonance imaging results\u0026nbsp;[17]. Therefore, if our measurement system correlates with other evaluation methods, it may also be possible to objectively evaluate development during the neonatal period, which is earlier than is possible with other evaluation methods.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlthough actigraphy has been studied as a tool to detect sleep in infants, several reports have suggested that the results cannot be validated for sleep/wake state discrimination in this population\u0026nbsp;[18, 19]. As such, actigraphy data should be interpreted with caution, and considered in conjunction with other relevant information and measurements in research and clinical settings. Overall, research on newborn body movements has provided valuable insights into the early development of motor skills, the relationship between body movements, and other aspects of neonatal development. These findings have implications for clinical practice, early intervention, and understanding human development in the early stages of life.\u003c/p\u003e\n\u003cp\u003eExtensive research has also been conducted on newborn body movements. The study of newborn body movements, also known as neonatal motor behavior, aims to understand how infants move and explore their environment, and how these movements develop over time. Researchers have used various methods, including observation, video analysis, and motion tracking, to study newborn body movements\u0026nbsp;[20-22]. The findings of this study may contribute to the understanding of infant motor development, reflexes, as well as the relationship between movement and brain development. However, the diagnostic accuracy of automatic movement recognition in predicting motor dysfunction in high-risk infants remains inferior to that of the clinical GMA in terms of sensitivity and specificity\u0026nbsp;[23]. Consequently, it is our duty to investigate the correlation between this measurement system and GMA in the future.\u003c/p\u003e\n\u003cp\u003eAlthough this study provides valuable insights in the field, certain limitations should be acknowledged. First, the sample size was relatively small, comprising only 23 newborns. A larger and more diverse sample size is required to enhance the generalizability of these findings. Second, the study design was cross-sectional, thereby limiting our ability to establish a causal relationship between body weight and movement or crying frequency. Longitudinal studies encompassing multiple time points would offer a more comprehensive understanding of these associations. Third, the long-term prognosis of neonates was not clarified in the present study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOverall, this study revealed a positive correlation among the objective quantification of body movements, cries, and body weight. Our research offers a more objective and reliable method for assessing neonatal health indicators by employing a portable battery-powered device to measure body movements and cries. Examining the long-term prognosis of children who deviate from this correlation may further enable early intervention for children with poor prognosis.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eUsing a highly sensitive body vibration meter equipped with two advanced piezoelectric meters, we were able to successfully detect newborn body movements in a non-invasive manner. These findings underscore the significance of body movements as indicators of neonatal well-being, and further provide valuable insights for the early identification and intervention of at-risk infants. The use of objective measurement tools, such as piezoelectric meters, enhances the accuracy and reliability of neonatal assessments, thereby paving the way for improved clinical practices and interventions. Further research is required to deepen our understanding of the intricate relationships among body weight, body movement, crying frequency, and neonatal health outcomes, ultimately contributing to enhanced neonatal care and improved long-term developmental trajectories.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki. The study protocol was approved by the Ethics Committees of the Tokyo Medical University (approval number: T2022-0095) and Kanazawa University (approval number: 237). All aspects of the study were explained to the parents of the newborns who provided written informed consent.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consents were obtained from the patients to publish the article and any accompanying images, figures, and clinical details.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData is provided within the manuscript.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe declare that we have no competing interests.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by JSPS KAKENHI (grant number: JP20H04003)\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTS, KS, MO, MN, SN, YS, GY, KO, KY, TN, YS, JK, NK, HN, and KS: Substantial contributions to the conception and design, acquisition of data, and analysis and interpretation of data. KS: Funding acquisition; Investigation; Methodology; Project administration. TS, KS, MO, TN, and KS drafted the article or revised it critically for important intellectual content. All authors read and approved the final manuscript.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe express our sincere gratitude to the newborn infants and their parents who participated in the study.\u003c/p\u003e\n\n\n"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eChoi H, Nho JH, Yi N, Park S, Kang B, Jang H: \u003cstrong\u003eMaternal, infant, and perinatal mortality statistics and trends in Korea between 2018 and 2020\u003c/strong\u003e. \u003cem\u003eKorean J Women Health Nurs \u003c/em\u003e2022, \u003cstrong\u003e28\u003c/strong\u003e(4):348-357.\u003c/li\u003e\n\u003cli\u003eKanazawa H, Yamada Y, Tanaka K, Kawai M, Niwa F, Iwanaga K, Kuniyoshi Y: \u003cstrong\u003eOpen-ended movements structure sensorimotor information in early human development\u003c/strong\u003e. \u003cem\u003eProc Natl Acad Sci U S A \u003c/em\u003e2023, \u003cstrong\u003e120\u003c/strong\u003e(1):e2209953120.\u003c/li\u003e\n\u003cli\u003eEinspieler C, Bos AF, Libertus ME, Marschik PB: \u003cstrong\u003eThe General Movement Assessment Helps Us to Identify Preterm Infants at Risk for Cognitive Dysfunction\u003c/strong\u003e. \u003cem\u003eFront Psychol \u003c/em\u003e2016, \u003cstrong\u003e7\u003c/strong\u003e:406.\u003c/li\u003e\n\u003cli\u003eHadders-Algra M: \u003cstrong\u003eGeneral movements: A window for early identification of children at high risk for developmental disorders\u003c/strong\u003e. \u003cem\u003eJ Pediatr \u003c/em\u003e2004, \u003cstrong\u003e145\u003c/strong\u003e(2 Suppl):S12-18.\u003c/li\u003e\n\u003cli\u003eMcIntire DD, Bloom SL, Casey BM, Leveno KJ: \u003cstrong\u003eBirth weight in relation to morbidity and mortality among newborn infants\u003c/strong\u003e. \u003cem\u003eN Engl J Med \u003c/em\u003e1999, \u003cstrong\u003e340\u003c/strong\u003e(16):1234-1238.\u003c/li\u003e\n\u003cli\u003ePomeroy E, Stock JT, Cole TJ, O\u0026apos;Callaghan M, Wells JC: \u003cstrong\u003eRelationships between neonatal weight, limb lengths, skinfold thicknesses, body breadths and circumferences in an Australian cohort\u003c/strong\u003e. \u003cem\u003ePLoS One \u003c/em\u003e2014, \u003cstrong\u003e9\u003c/strong\u003e(8):e105108.\u003c/li\u003e\n\u003cli\u003eMolteno C, Grosz P, Wallace P, Jones M: \u003cstrong\u003eNeurological examination of the preterm and full-term infant at risk for developmental disabilities using the Dubowitz Neurological Assessment\u003c/strong\u003e. \u003cem\u003eEarly Hum Dev \u003c/em\u003e1995, \u003cstrong\u003e41\u003c/strong\u003e(3):167-176.\u003c/li\u003e\n\u003cli\u003eEinspieler C, Prechtl HF: \u003cstrong\u003ePrechtl\u0026apos;s assessment of general movements: a diagnostic tool for the functional assessment of the young nervous system\u003c/strong\u003e. \u003cem\u003eMent Retard Dev Disabil Res Rev \u003c/em\u003e2005, \u003cstrong\u003e11\u003c/strong\u003e(1):61-67.\u003c/li\u003e\n\u003cli\u003eRicardo LIC, ICM DAS, Martins RC, Wendt A, Goncalves H, Hallal PRC, Wehrmeister FC: \u003cstrong\u003eProtocol for Objective Measurement of Infants\u0026apos; Physical Activity using Accelerometry\u003c/strong\u003e. \u003cem\u003eMed Sci Sports Exerc \u003c/em\u003e2018, \u003cstrong\u003e50\u003c/strong\u003e(5):1084-1092.\u003c/li\u003e\n\u003cli\u003eZeevenhooven J, de Bruin FE, Schappin R, Vlieger AM, van der Lee JH, Haverman L, van Sleuwen BE, L\u0026apos;Hoir MP, Benninga MA: \u003cstrong\u003eFollow-up of infants with colic into childhood: Do they develop behavioural problems?\u003c/strong\u003e \u003cem\u003eJ Paediatr Child Health \u003c/em\u003e2022, \u003cstrong\u003e58\u003c/strong\u003e(11):2076-2083.\u003c/li\u003e\n\u003cli\u003eEinspieler C, Prechtl HF, Ferrari F, Cioni G, Bos AF: \u003cstrong\u003eThe qualitative assessment of general movements in preterm, term and young infants--review of the methodology\u003c/strong\u003e. \u003cem\u003eEarly Hum Dev \u003c/em\u003e1997, \u003cstrong\u003e50\u003c/strong\u003e(1):47-60.\u003c/li\u003e\n\u003cli\u003eShinya Y, Kawai M, Niwa F, Myowa-Yamakoshi M: \u003cstrong\u003ePreterm birth is associated with an increased fundamental frequency of spontaneous crying in human infants at term-equivalent age\u003c/strong\u003e. \u003cem\u003eBiol Lett \u003c/em\u003e2014, \u003cstrong\u003e10\u003c/strong\u003e(8).\u003c/li\u003e\n\u003cli\u003eShinohara H, Kodama H: \u003cstrong\u003eRelationship between duration of crying/fussy behavior and actigraphic sleep measures in early infancy\u003c/strong\u003e. \u003cem\u003eEarly Hum Dev \u003c/em\u003e2012, \u003cstrong\u003e88\u003c/strong\u003e(11):847-852.\u003c/li\u003e\n\u003cli\u003eDubowitz LM, Dubowitz V, Goldberg C: \u003cstrong\u003eClinical assessment of gestational age in the newborn infant\u003c/strong\u003e. \u003cem\u003eJ Pediatr \u003c/em\u003e1970, \u003cstrong\u003e77\u003c/strong\u003e(1):1-10.\u003c/li\u003e\n\u003cli\u003eBultmann CS, Orlikowsky T, Hausler M, Trepels-Kottek S, Disselhorst-Klug C, Schoberer M: \u003cstrong\u003eSpontaneous movements in the first four months of life: An accelerometric study in moderate and late preterm infants\u003c/strong\u003e. \u003cem\u003eEarly Hum Dev \u003c/em\u003e2019, \u003cstrong\u003e130\u003c/strong\u003e:1-9.\u003c/li\u003e\n\u003cli\u003eYachi K, Nemoto T, Shimada K: \u003cstrong\u003eQuantification of body movement measurements in low-birthweight infants\u003c/strong\u003e. \u003cem\u003eJournal of the Tsuruma Health Science Society Kanazawa University \u003c/em\u003e2016, \u003cstrong\u003e40\u003c/strong\u003e(1):11-19.\u003c/li\u003e\n\u003cli\u003eZhou J, Li S, Gu L, Zhang X, Tang Z: \u003cstrong\u003eGeneral movement assessment is correlated with neonatal behavior neurological assessment/cerebral magnetic resonance imaging in preterm infants\u003c/strong\u003e. \u003cem\u003eMedicine (Baltimore) \u003c/em\u003e2021, \u003cstrong\u003e100\u003c/strong\u003e(37):e27262.\u003c/li\u003e\n\u003cli\u003eRioualen S, Roue JM, Lefranc J, Gouillou M, Nowak E, Alavi Z, Dubourg M, Sizun J: \u003cstrong\u003eActigraphy is not a reliable method for measuring sleep patterns in neonates\u003c/strong\u003e. \u003cem\u003eActa Paediatr \u003c/em\u003e2015, \u003cstrong\u003e104\u003c/strong\u003e(11):e478-482.\u003c/li\u003e\n\u003cli\u003eDerbin M, McKenna L, Chin D, Coffman B, Bloch-Salisbury E: \u003cstrong\u003eActigraphy: Metrics reveal it is not a valid tool for determining sleep in neonates\u003c/strong\u003e. \u003cem\u003eJ Sleep Res \u003c/em\u003e2022, \u003cstrong\u003e31\u003c/strong\u003e(1):e13444.\u003c/li\u003e\n\u003cli\u003eLevy J, Hassan F, Plegue MA, Sokoloff MD, Kushwaha JS, Chervin RD, Barks JD, Shellhaas RA: \u003cstrong\u003eImpact of hands-on care on infant sleep in the neonatal intensive care unit\u003c/strong\u003e. \u003cem\u003ePediatr Pulmonol \u003c/em\u003e2017, \u003cstrong\u003e52\u003c/strong\u003e(1):84-90.\u003c/li\u003e\n\u003cli\u003eLong X, Otte R, Sanden EV, Werth J, Tan T: \u003cstrong\u003eVideo-Based Actigraphy for Monitoring Wake and Sleep in Healthy Infants: A Laboratory Study\u003c/strong\u003e. \u003cem\u003eSensors (Basel) \u003c/em\u003e2019, \u003cstrong\u003e19\u003c/strong\u003e(5).\u003c/li\u003e\n\u003cli\u003eFontana C, Ottaviani V, Veneroni C, Sforza SE, Pesenti N, Mosca F, Picciolini O, Fumagalli M, Dellaca RL: \u003cstrong\u003eAn Automated Approach for General Movement Assessment: A Pilot Study\u003c/strong\u003e. \u003cem\u003eFront Pediatr \u003c/em\u003e2021, \u003cstrong\u003e9\u003c/strong\u003e:720502.\u003c/li\u003e\n\u003cli\u003eRaghuram K, Orlandi S, Church P, Chau T, Uleryk E, Pechlivanoglou P, Shah V: \u003cstrong\u003eAutomated movement recognition to predict motor impairment in high-risk infants: a systematic review of diagnostic test accuracy and meta-analysis\u003c/strong\u003e. \u003cem\u003eDev Med Child Neurol \u003c/em\u003e2021, \u003cstrong\u003e63\u003c/strong\u003e(6):637-648.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"body weight, body movement measuring system, crying, objective neonatal motor activity assessment","lastPublishedDoi":"10.21203/rs.3.rs-5392167/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5392167/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eDevelopmental support for newborns is a global public health concern. Neonatal body movements serve as key indicators of overall health, playing a pivotal role in neurodevelopment. Conventional methods of assessing newborn body movements are subjective, with limited accuracy and reliability. In this study we investigated the correlation between body weight and movements using an originally developed, portable, and battery-powered device. We also explored the relationship between the frequency of newborn cries and their body weight.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis observational study enrolled newborns collected from two university hospitals from August 2022 to November 2023. Movement was measured using a body movement measuring device equipped with piezoelectric sensors, a foot switch, and acceleration inputs. Body movements were represented as piezoelectric peaks. Correlation and regression analyses explored the relationships among neonatal body weight (at the time of the study), body movement, crying frequency, and crying duration.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA positive correlation was identified between body weight and number of body movements (R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.2884). The regression analysis revealed a linear relationship between body weight and body movements per minute, and body weight and the number of cries per hour. Crying time also increased with increasing body weight (R\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.5079).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eOverall, these results indicate that the body movement measuring system allowed the non-invasive detection of neonatal body movements, establishing a robust positive correlation between body weight and the number of body movements. This method may offer an accurate and objective means to assess newborn body movements and crying frequency to identify at-risk infants who require early intervention.\u003c/p\u003e","manuscriptTitle":"Use of a portable anthropometer to assess body weight, body movement, and crying frequency in newborns: An observational study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-09 15:49:02","doi":"10.21203/rs.3.rs-5392167/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f082e70a-293e-4638-b301-299b94c5f5f5","owner":[],"postedDate":"December 9th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-19T19:39:14+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-09 15:49:02","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5392167","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5392167","identity":"rs-5392167","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}