Co-bedding twins

Question
What is the best information on safe sleeping for twins. I have a lot of mothers asking me if the twins can share the same cot while they are small, or do they need separate beds?? I'm not sure on the exact answer to this?

Response
Given that there is no evidence for or against when it comes to SIDS it becomes a risk benefit analysis decision. If the babies are protected by ‘face-up, face clear, smokefree’ care then their SUDI risk is managed. However, if they have been exposed to smoking in pregnancy or will be going home to smoking family, and if the cobedding as it is practiced increases the chance of asphyxia from position/bedding/environment factors then sleeping in their own protected space would be recommended. Also, if they are premature, and therefore at greater risk of suffocation and SUDI, then ‘own space’ principle takes precedence.

So it cannot be a simple ‘yes’ or ‘no’ response as safety depends on the principles of care, vulnerability of the babies and safety of the environment. I have added a current article (below) discussing practical issues for cobedding in NICU that may be of interest.

Should Twins Sleep Together in the NICU?

Cobedding of Twins and Multiples in Hospital Settings

By Cheryl Morrissette, About.com Guide

Updated September 09, 2010

About.com Health's Disease and Condition content is reviewed by the Medical Review Board

There are benefits and risks when twins sleep together in the NICU.

As a NICU nurse, I love letting twins sleep together when under my care. The practice of letting twins sleep together in the same crib or incubator is called cobedding, and can be done with twins, triplets, or other multiples.

While there are benefits to letting twins sleep together in the NICU, there may also be drawbacks to cobedding. Unfortunately, there haven't been a lot of studies done on the benefits and risks of cobedding multiples.

Benefits When NICU Twins Sleep Together

Although nurses, parents, and case studies agree that there are definite benefits to letting twins sleep together in the NICU, there aren't enough large, well designed scientific studies to prove any of the possible benefits for certain. Possible benefits of cobedding multiples include:

· Enhanced developmental care: Developmental care is a type of care giving where preemies' parents and nurses try to ease the transition to life by providing care that mimics the womb as much as possible. Letting twins sleep together is the most basic way to promote developmental care. Cobedded multiples can see, touch, and smell each other at all times, much like they could before birth.

· Less irritability: Looking at heart rate and other stress cues, cobedded twins seem less irritable than other twins. When twins sleep together, they coordinate their sleep/wake cycles and have less stress.

· Better weight gain: When twins sleep together, they seem to gain weight better than multiples who are not cobedded.

· Reduced apnea: Twins who sleep together may have fewer episodes of apnea than twins who are not cobedded. Short periods of apnea (<10 seconds) seem to be most affected.

· Other possible benefits: Although no studies back up these benefits, case reports and nurses' observations have shown other benefits of cobedding multiples. When twins sleep together, they seem to have happier parents, fewer episodes of bradycardia, better thermoregulation, and lower oxygen needs.

Risks When Twins Sleep TogetherIt's important to note that no well-designed scientific studies have found any true risks to cobedding multiples in the NICU. However, nurses reports and observations show some possible drawbacks to letting twins sleep together:

· Temperature instability: Although better thermoregulation is a possible benefit to cobedding multiples, poor thermoregulation is a possible risk when twins are are different sizes. A smaller twin sleeping with a larger twin, for example, may get cold easily, or a larger twin could get hot.

· Infection: Although there have been no reports of infection passing from one twin to another due to cobedding, infection remains a possible risk when twins sleep together.

· Exposure to supplemental oxygen: When twins sleep together but only one is on a nasal cannula, the other baby may be exposed to additional oxygen. High levels of supplemental oxygen can increase the risk of retinopathy of prematurity (ROP).

· Errors in caregiving: When multiples are in the same bed together, nurses may inadvertently give the wrong baby a medication, mix up feeding amounts, or make other errors. Babies can also pull out each others feeding tubes or other equipment.
Sources:
Hayward, Kathryn. "Cobedding of Twins: A Natural Extension of the Socialization Process?" American Journal of Maternal and Child Nursing July/Aug 2003; 28, 260-264
Tomashek, K, Wallman, C, and the Committee on Fetus and Newborn. "Cobedding Twins and Higher-Order Multiples in a Hospital Setting." Pediatrics Dec 2007; 120, 1359-1366.