TABLE 1

Published Analytic Studies on Cobedding Multiples in Hospital Settings

Author (Year)Type of StudyStudy InclusionStudy OutcomeSeparately Bedded MultiplesCobedded MultiplesStatistical 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 incubatorsMultiples 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, g1348 ± 1451439 ± 134Significant difference (ANOVA, P = .0001); the authors concluded: “statistically significant difference but no clinical significance.”
(2) 5-d average breast milk/formula ingestion ± SD,mL195.6 ± 21.7200.6 ± 22.4Significant 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 min182.6 ± 8.1180.2 ± 11.3Significant 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 rateNo 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 NICUTwins 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, g1435.8 ± 332.31550.5 ± 282.8No significant difference
    Week 1, g1572 ± 1491643 ± 14.5Significant difference (P = .001)
    Week 2, g1692.8 ± 16.31754 ± 19.8Significant difference (P = .02)
    Week 3, g1795.8 ± 22.41804.5 ± 24.7No significant difference
(2) Median No. of combined apnea, bradycardia, and desaturation events per group per weekNo 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 twinsAll 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 cultures5 (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 enterocolitisNo 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 birthMultiples <37 wk gestation; patient in NICU; included 31 separately bedded and 31 cobedded multiple-gestation infants(1) No. of body-temperature depressionsSignificant 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 depressionsNo 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 multiplesMultiples <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 insultsNo 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 NICUMultiples 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, %83100Significant 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 hemorrhageNo 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 responsesNo significant differences
Touch et al39 (2002)Blinded study of cardiorespiratory event recordings of twins 12 h before cobedding and for first 12 h during cobeddingTwins <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 episodes5218Significant 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 pressureNo significant differences
  • ANOVA indicates analysis of variance.