Abstract
BackgroundCo-bedding, a developmental care strategy, is the practice of caring for diaper clad twins in one incubator (versus separating and caring for each infant in separate incubators), thus creating the opportunity for skin-to-skin contact and touch between the twins. In studies of mothers and their infants, maternal skin-to-skin contact has been shown to decrease procedural pain response according to both behavioral and physiological indicators in very preterm neonates. It is uncertain if this comfort is derived solely from maternal presence or from stabilization of regulatory processes from direct skin contact. The intent of this study is to compare the comfort effect of co-bedding (between twin infants who are co-bedding and those who are not) on infant pain response and physiologic stability during a tissue breaking procedure (heelstick).Methods/DesignMedically stable preterm twin infants admitted to the Neonatal Intensive Care Unit will be randomly assigned to a co-bedding group or a standard care group. Pain response will be measured by physiological and videotaped facial reaction using the Premature Infant Pain Profile scale (PIPP). Recovery from the tissue breaking procedure will be determined by the length of time for heart rate and oxygen saturation to return to baseline. Sixty four sets of twins (n = 128) will be recruited into the study. Analysis and inference will be based on the intention-to-treat principle.DiscussionIf twin contact while co-bedding is determined to have a comforting effect for painful procedures, then changes in current neonatal care practices to include co-bedding may be an inexpensive, non invasive method to help maintain physiologic stability and decrease the long term psychological impact of procedural pain in this high risk population. Knowledge obtained from this study will also add to existing theoretical models with respect to the exact mechanism of comfort through touch.Trial registrationNCT00917631
Highlights
IntroductionCo-bedding, a developmental care strategy, is the practice of caring for diaper clad twins in one incubator (versus separating and caring for each infant in separate incubators), creating the opportunity for skin-to-skin contact and touch between the twins
Co-bedding, a developmental care strategy, is the practice of caring for diaper clad twins in one incubator, creating the opportunity for skin-to-skin contact and touch between the twins
An increasing number of multiple pregnancies and increasing obstetric intervention at preterm gestation has led to a rising number of preterm twin infants being admitted into Neonatal Intensive Care Units (NICU)
Summary
Co-bedding, a developmental care strategy, is the practice of caring for diaper clad twins in one incubator (versus separating and caring for each infant in separate incubators), creating the opportunity for skin-to-skin contact and touch between the twins. In studies of mothers and their infants, maternal skin-to-skin contact has been shown to decrease procedural pain response according to both behavioral and physiological indicators in very preterm neonates. The intent of this study is to compare the comfort effect of co-bedding (between twin infants who are co-bedding and those who are not) on infant pain response and physiologic stability during a tissue breaking procedure (heelstick). An increasing number of multiple pregnancies and increasing obstetric intervention at preterm gestation has led to a rising number of preterm twin infants being admitted into Neonatal Intensive Care Units (NICU) These preterm infants undergo repeated and often untreated procedural pain that can contribute to immediate stress and may have a long term impact on the normal maturation of regulatory systems. Pain response will be measured in all infants and will be determined by physiological and behavioral reaction
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