Should Twins and Multiples Co-Bed in the NICU?

As a Neonatal Intensive Care Unit (NICU) nurse, I love letting multiples sleep together when under my care. The practice of letting babies sleep together in the same crib or incubator is called cobedding and can be done with twins, triplets, or other multiples.

While there are benefits to letting multiples sleep together in the NICU, there may also be drawbacks to cobedding.

Possible Benefits 

Although nurses, parents and case studies agree that there are benefits to letting multiples sleep together in the NICU, there aren't enough large, well-designed scientific studies to prove any of the possible benefits for certain. Possible benefits of cobedding multiples include:

• Enhanced developmental care: Developmental care is easing the transition to life by providing care that mimics the womb as much as possible. Letting multiples sleep together is the most basic way to promote developmental care. Cobedded multiples can see, touch, and smell each other at all times, much like they could before birth.
• Less irritability: Looking at heart rate and other stress cues, cobedded multiples seem less irritable than other multiples. When multiples sleep together, they coordinate their sleep/wake cycles and have less stress.
• Better weight gain: When multiples sleep together, they seem to gain weight better than multiples who are not cobedded.
• Other possible benefits: Although no studies back up these benefits, case reports and nurses' observations have shown other benefits of cobedding multiples, including happier parents, fewer episodes of bradycardia, better thermoregulation, and lower oxygen needs.

Possible Risks 

It's important to note that no well-designed scientific studies have found any true risks to cobedding multiples in the NICU. However, nurses' reports and observations show some possible drawbacks to letting multiples sleep together:

• Temperature instability: Although better thermoregulation is a possible benefit to cobedding multiples, poor thermoregulation is a possible risk when multiples are different sizes. For example, a smaller twin sleeping with a larger twin, for example, may get cold easily, or a larger twin could get hot.
• Infection: Although there have been no reports of infection passing from one multiple to another due to cobedding, infection remains a possible risk when multiples sleep together.
• Exposure to supplemental oxygen: When multiples sleep together but only one is on a nasal cannula, the other baby may be exposed to additional oxygen. High levels of supplemental oxygen can increase the risk of retinopathy of prematurity (ROP).
• Errors in caregiving: When multiples are in the same bed together, nurses may inadvertently give the wrong baby a medication, mix up feeding amounts, or make other errors. Babies can also pull out each other's feeding tubes or other equipment.

Safe Sleep Guidelines

The American Academy of Pediatrics (AAP) guidelines for safe sleep indicate that babies should be put to bed on their backs in a crib with nothing else in it. That means no pillows, blankets, crib bumpers, toys—or siblings. When twins cobed in the NICU, it is usually just for a visit; not an extended period of sleep. When you bring your babies home, they should each have their own safe place to sleep.