Published Analytic Studies on Cobedding Multiples in Hospital Settings
| Author (Year) | Type of Study | Study Inclusion | Study Outcome | Separately Bedded Multiples | Cobedded Multiples | Statistical Test and Findings |
|---|---|---|---|---|---|---|
| Byers et al36 (2003) | Prospective, randomized, repeated-measures study that compared physiological stability and behavioral effects of cobedding with separately bedded preterm multiples in incubators | Multiples of <37 wk gestation; normal vital signs for 24 h; normal last white cell count; no known infection; nonventilated; combined weight not too great to be cobedded in incubator; included 21 separately bedded and 16 cobedded multiple-gestation infants | (1) 5-d average daily weight gain ± SD, g | 1348 ± 145 | 1439 ± 134 | Significant difference (ANOVA, P = .0001); the authors concluded: “statistically significant difference but no clinical significance.” |
| (2) 5-d average breast milk/formula ingestion ± SD,mL | 195.6 ± 21.7 | 200.6 ± 22.4 | Significant difference (ANOVA, P = .0001); the authors concluded, “statistically significant difference but no clinical significance.” | |||
| (3) 5-d average highest-activity heart rate ± SD, beats per min | 182.6 ± 8.1 | 180.2 ± 11.3 | Significant difference (ANOVA, P = .0001); high-activity heart rate higher on days 1 and 2 for cobedded infants and lower on days 3–5 | |||
| (4–12) 5-d average baseline and activity heart and respiratory rates and oxygen saturation, stress cues, and highest-activity respiratory rate | No significant differences | |||||
| Chin et al44 (2006) | Prospective randomized study that compared differences in growth and physiological regulation in cobedded preterm twins vs individually bedded preterm twins in an NICU | Twins 28–34 wk gestation; off ventilator; oxygen if required administered by nasal cannula only; stable condition; free from infection or rash of unknown etiology; parental consent; included 40 separately bedded and 42 cobedded multiples | (1) Adjusted mean weekly weight gain ± SE at baseline, g | 1435.8 ± 332.3 | 1550.5 ± 282.8 | No significant difference |
| Week 1, g | 1572 ± 149 | 1643 ± 14.5 | Significant difference (P = .001) | |||
| Week 2, g | 1692.8 ± 16.3 | 1754 ± 19.8 | Significant difference (P = .02) | |||
| Week 3, g | 1795.8 ± 22.4 | 1804.5 ± 24.7 | No significant difference | |||
| (2) Median No. of combined apnea, bradycardia, and desaturation events per group per week | No significant differences | |||||
| LaMar and Dowling42 (2006) | Retrospective cohort study that compared incidence of infection from 7 d after delivery to discharge for cobedded and separately bedded preterm twins | All twins 23–35 wk gestation; patient in NICU from 1992–2001; no need for medication to maintain blood pressure; no umbilical lines; no chest tubes; no phototherapy; no ventilatory support including nasal continuous positive airway pressure; included 112 separately bedded twin infants born 1992–1996 and 94 cobedded twin infants born 1997–2001 | (1) No. (%) of positive blood cultures | 5 (4.5) | 3 (3.2) | Significant difference (χ2 = 4.08; P = .043) |
| (2–4) No. of sepsis evaluations, incidence of pneumonia, and incidence of necrotizing enterocolitis | No significant differences | |||||
| Longobucco et al43 (2000) | Prospective cohort study of cobedded multiples whose growth and physiological parameters were compared to separately bedded historical controls matched for gestational age and size at birth | Multiples <37 wk gestation; patient in NICU; included 31 separately bedded and 31 cobedded multiple-gestation infants | (1) No. of body-temperature depressions | Significant difference (P = .02); the authors concluded that it was “likely a spurious result.” | ||
| (2–12) Daily average weight gain, heart rate, respiratory rate, body temperature, and apnea episodes; incidence of periodic breathing and length of stay; No. of heart rate elevations, respiratory rate elevations, and temperature depressions | No significant differences | |||||
| Lutes and Altimier41 (2001) | Prospective randomized study of the practice of cobedding vs separate bedding effect on weight, head circumference, and length among preterm multiples | Multiples <37 wk gestation; birth weight <1500 g; patient in NICU; nonventilated; no birth defects; no severe neurosensory defects; no infection or documented sepsis; cobedded at least 2 wk; included 30 twins, 21 triplets and 8 quads infants (all separately bedded) and 46 cobedded twins, 12 cobedded triplets, and 4 cobedded quads infants | (1) Average weekly: weight gain, kcal/kg, change in head circumference, and growth in length; No. of medication errors, nosocomial infections, sepsis workups initiated, and thermal insults | No significant difference | ||
| Polizzi et al37 (2003) | Retrospective cohort study of outcomes among cobedded and separately bedded multiples (71 twin pairs, 3 sets of triplets) admitted to a 78-bed NICU | Multiples born Jan 1, 1999, through Mar 3, 2001; not transferred; not adopted; included 116 separately bedded and 39 cobedded multiple-gestation infants | (1) Cobedded after discharge to home, % | 83 | 100 | Significant difference (χ2 = 4.05; P = .044) |
| (2–9) No. of days: on ventilator, in incubator, to full nipple feeding, and in an open crib; discharge weight, length of stay, and complications such as patent ductus arteriosus or intraventricular hemorrhage | No significant differences | |||||
| Stainton et al38 (2005) | Cohort study of responses among twins cobedded for ≥24 h (group A) and twins with no cobedding experience (group B) | Twins; medically stable; nonventilated; infection free with no open lesions; cared for in same-level nursery; included 9 separately bedded and 10 cobedded twins | (1–4) Mean self-regulatory and stressful responses | No significant differences | ||
| Touch et al39 (2002) | Blinded study of cardiorespiratory event recordings of twins 12 h before cobedding and for first 12 h during cobedding | Twins <37 wk gestation; born Apr 1, 1999, through Jul 31, 2000; no arterial lines; no ventilatory support including nasal continuous positive airway pressure; no ongoing sepsis evaluation; included 22 separately bedded and 22 cobedded twins | (1) Apnea or a pause in respiration of >10 s, No. of episodes | 52 | 18 | Significant difference (t test, P < .05) |
| (2–10) Apnea (A) of 15–20 or >20 s; bradycardia (B) or a decline in heart rate to <80 beats per min, A/B, periodic breathing, or an adverse event; mean heart rate, respiratory rate, or arterial blood pressure | No significant differences |
ANOVA indicates analysis of variance.