Co-Bedding of Multiples in NICU
by Linda Lutes, M.Ed
Reproduced with permission from Twin Services Reporter,
Neonatology is one of the youngest sciences, and the practice of
developmental or holistic care in relation to newborns is still in
the "preemie" stages. Traditional care of multiples has focused on
meeting the health requirements of each baby. Standard practice has
been to separate multiples in the neonatal intensive care unit (NICU)
and sometimes to place them in different hospitals. Little, if any,
attention has been paid to the impact of their separation on the long
term mental health of the babies and on their families.
When we take a developmental approach to the population of our NICU's,
where multiple births are common, we begin to recognize the unique needs
of multiples and their families. We are beginning to ask what it was
like for multiples to share a womb from conception until delivery. How
did they interact in the womb? How do we affect their development when
we separate these siblings who have been developing together since conception?
Do we fully understand, recognize, and acknowledge the issues related
to the mental health of multiples? Are we mindful of the extraordinary
physical and emotional stress imposed upon a family when their babies
are placed in separate hospitals or nurseries for care?
Co-bedding of multiples is evolving as a practice which attempts to
replicate and capitalize upon their unique prenatal environment and
experience. When multiples are swaddled together in the same blanket
and boundary they have the opportunity to co-regulate and to continue
to progress in their unique interactive development. Some hospitals
are putting multiples together while they are still incubated; some
are co-bedding them under bili-lights; others wait until they are on
minimal or no supplemental oxygen; and others wait until they are in
an open crib on room air. Infants that are co-bedded within a short
period of time after birth appear to handle the stress of the NICU better
than those who are separated. Physicians have reported getting a truer
picture of the multiples when they are bedded together, and having families
that are happier with fewer complaints.
I encourage everyone involved with multiples to consider the use of
co-bedding. Discussion of this concept needs to include physicians,
staff, ancillary personnel, infection control and the parents. The majority
of the staff come around as soon as they see multiples together. Everything
"falls into place."
Editor's note. Linda Lutes, M. Ed., of the University of Oklahoma Health
Science Center at Children's Hospital of Oklahoma City conducted a pilot
study in six hospitals of the co-placement of multiples in NICU.
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