Co-bedding twins and higher-order multiples

VUMC Policy Click Here

Co-bedding twins and higher-order multiples may result in an increase in physiologic and neurodevelopmental stability. Co-bedding may be offered as an option to parents once the medical and nursing teams have identified each of the respective infants as stable.

Co-bedded infants should not be receiving ventilator or pressor support; their individual temperatures should already be stable, and they should be at least 12 hours of age. Co-bedded infants may receive IV fluids, orogastric feeds, nasal cannula oxygen, and phototherapy.

The infants may be placed together in an open bed warmer, isolette, or crib. They should be placed side-by-side either facing one another or one can face the other’s back in a tucked position. One blanket should be lightly swaddled around the infants allowing no space between them. They may be dressed or undressed.

When initiating co-bedding, the baby’s temperatures should be monitored every 1-2 hours until stable for 4 hours. If using an isolette or radiant warmer, the equipment should be set to meet the thermal needs of the larger baby.

All co-bedded infants must have two identification bands on at all times. The infants will be identified with different colored stickers, numbers, and/or names on all equipment, charts, IV and feeding tubing.

Hand washing between co-bedded infants is not necessary unless handling blood or body fluids. The infants may be separated if one becomes unstable. Re-evaluation and a new physician order should occur before resuming co-bedding.

References:

Hiedgery-Nyquist K and Lutes LM. Co-bedding twins: A developmentally supportive care strategy. JOGNN 1998;27:450-456.

Lutes LM. Bedding twins/multiples together. Neonatal Network 1996; 15 (7).

This protocol was approved at the 3/15/00 Nursery Policy & Procedure meeting.