Project Description:
The practice of placing twins in the same crib or isolette, also called co-bedding,has become common practice in many Neonatal Intensive Care Units (NICU) across the country. The stated benefits of co-bedding include enhanced physiologic status (i.e., improved growth and development), stabalization of vital signs and temperature, enhanced parent-infant bonding, improved nurse-parent communication, and decreased length of stay. This widespread practice is concerning, given the lack of empirical evidence supporting the procedure. To date, there are two empirical articles investigating co-bedding and both report some beneficial effects and no adverse outcomes. One study found a significant decrease in the number of apnea events 10-15 seconds in duration when infants were co-bedded with a sibling. this study was based on a small number of subjects and used an event recorder to monitor respiratory behaviors.
The purpose of this proposed study will current literature on the benefits and monitor the preceived risks of instituting co-bedding as regular practice in a NICU. Results from this study will provide feedback to the Sioux Valley Hospital NICU Performance Enhancement Committee to directly inform and improve clinical practice. This project represents a collaborative effort between the Center for Disabilities part of the Department of Pediatics, University of South Dakota School of Medicine, and the Sioux Valley Hospital NICU.
This study will utilize a within-group research design to allow each infant to serve as his/her own control. Each infant will be monitored on a pneumogram for 12 hours while bedded traditionally and 12 hours while bedded with a sibling. The order in which infants are exposed to each condtion (i.e., traditional vs. co-bedded) will be counter-balanced across infant pairs to control for ordering effects. A number of dependent variables will be assessed throughout this study to examine the effects of co-bedding on various clinical and developmental outcome measures. These variables include the occurrences of central apnea, bradycardia, and apnena/bradycardia episodes. Information on periodic breathing patterns and the percent of time spent in quiet sleep will also be calculated. Further information will be collected regarding each infant's body temperature compared with the temperature and setting of the isolette. Floral swabs will also be collected pre- and post- co-bedding to determine if there is any risk of cross-infection associated with the project. Finally, a survey will be mailed to parents 3 months post-discharge to determine their satisfaction with co-bedding in the NICU and details regarding their child's current sleep environment.
It is anticipated that numerous publications will emerge from this research project including further analysis regarding the relationship between co-bedding and central apnea episodes, risk of cross-infection between co-bedded sibling pairs, and demonstration articles on the direct relationship between research and practice.
Keyword(s):
Cobedding, NICU, Multiples, Sleep
