Introduction A twin who had died while sleeping with his twin was discussed at the Child Death Overview Panel. Several panel members asked if cobedding was normal and best practice.
Aim A literature search was conducted to establish the frequency of cobedding and benefits and risks.
Method Literature review.
Results Most studies looking at cobedding have been undertaken in hospital.
61% of British families cobedded twins at one month, 40% cobedded at 3 months. A New Zealand study found 54% cobedding at 6 weeks; decreasing to 31% by 4 months and 10% at 8 months. A US study found > 50% of twins were cobedded at 4 and 9 weeks.
Many magazines for parents suggest that cobedding is a natural extension of the intrauterine environment, increasing bonding, and increasing sleep duration with synchrony of waking and feeding periods making care easier.
Preterm twins who were cobedded in NICU spent more time in the same state (p < 0.01), were more often in quiet sleep (p < 0.01) and cried less (p < 0.01). There was no difference in physiological parameters, caregiver error or apnoeas.
Cobedding of healthy preterm twins reduces the occurrence of central apnoeas (p < 0.05), perhaps due to more frequent arousal by the twin or a positive physiological response to contact between twins resulting in a more regular breathing pattern.
Cobedding enhances recovery of preterm twins undergoing heel lance, but does not reduce pain scores. Cobedding in NICU is not associated with an increased incidence of infection, with a statistically significant higher number of blood cultures in non-cobedded infants.
Twins were videoed sleeping together at home in head-to-head and side-by-side configurations. Sleep variables were unaffected by cobedding configuration. Those side-by-side were observed to occasionally impinge on, but not obstruct, one another’s airways, with an arm across the other’s face. Cobedded infants do not exhibit increased core temperature.
Conclusion Current advice is that cobedding with a parent is associated with increased sudden infant death syndrome (SIDS) risk. Whilst there appears to be some benefits to twins cobedding, there is a lack of evidence in relation to the risk of SIDS. Further research is necessary.
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