In The Event You Co-Bed Twins and Multiples within the NICU

 

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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. 1  While there are benefits to letting multiples sleep together in the NICU, there may also be drawbacks to cobedding. Reports of twins sharing a bed in the neonatal intensive care unit (NICU) first appeared in the lay literature about 15 years ago (Elliot, 1996; Sheehan, 1995).

An unstable premature twin showed signs of improvement in heart rate, breathing, and sleeping when placed close to her sibling in the same incubator (Sheehan, 1995, 1996). Handbook of Neonatal Intensive Care by Merenstein and Gardner (widely considered the “NICU bible” in the US) says that support for cobedding is mainly anecdotal, with little research to back it or refute it. They do cite one recent study that showed a decrease in apneic episodes, but it only involved seven sets of twins. Twins, triplets, and other multiples often are admitted to the NICU, as they tend to be born earlier and smaller than single birth babies.

Babies with medical conditions such as heart problems, infections, or birth defects are also cared for in the NICU. In an ideal world, all twin pregnancies would reach that magic 36-38 weeks, and the likelihood of NICU (Neonatal Intensive Care Unit) time at this gestational point is very low. According to the March of Dimes, however, the average gestation for twins is.

Your Twins’ NICU Stay – 5 Things You Should Know On the 24 th of July, my wife and I were blessed with identical twin girls. As most parents of multiples know, twins usually are delivered early. On July 23 rd, during one of our bi-weekly scan.

It’s very possible you could have one twin in the NICU, while the other twin is home with you. This happened to our family and it was stressful. In our case, the twins were born at 35.5 weeks, and they were both brought to the Continuing Care Nursery.

This meant they required extra care, but not to the same level as the NICU. Spoiler alert: my twins spent 10.5 and 11 weeks in the NICU, but today they are completely healthy. The NICU can be a terrifying, intimidating place, but it can also be a warm, supportive resource. The more you can prepare for a possible NICU stay, the better equipped you’ll be if that day does arrive. The best thing you can do is plan ahead to find the highest level NICU in your region, in the event that your babies do need to spend time there.

In addition to a birth plan, make what I like to call a BUMP plan (a baby urgent medical plan) that clearly lists the closest NICU IIIC (the highest level). Although co-bedded twins appeared to have lower pain scores 30 seconds after heel lance on a scale of 0 to 21 (MD-0.96, 95% CI-1.68 to -0.23; two studies; 117 pairs of twins; I 2 = 75%; evidence of low quality), they had higher pain scores 90 seconds after the procedure (MD 1.00, 95% CI 0.14 to 1.86; one study; 62 pairs of twins).

List of related literature:

Currently, there is no evidence to establish cobedding of multiples outside the NICU as a safe or unsafe sleep practice.

“Perinatal Nursing” by Kathleen Rice Simpson, Patricia A. Creehan, Association of Women's Health, Obstetric, and Neonatal Nurses
from Perinatal Nursing
by Kathleen Rice Simpson, Patricia A. Creehan, Association of Women’s Health, Obstetric, and Neonatal Nurses
Wolters Kluwer Health/Lippincott Williams & Wilkins, 2008

As a consequence, multiples have a fivefold increased risk of stillbirth and a sevenfold increased risk of neonatal death (Scher et al., 2002).

“Avery's Diseases of the Newborn E-Book” by Christine A. Gleason, Sandra E Juul
from Avery’s Diseases of the Newborn E-Book
by Christine A. Gleason, Sandra E Juul
Elsevier Health Sciences, 2017

Multiples have higher rates of preeclampsia.

“Maternal-Fetal Evidence Based Guidelines” by Vincenzo Berghella
from Maternal-Fetal Evidence Based Guidelines
by Vincenzo Berghella
CRC Press, 2017

Offering the option of a multifetal reduction procedure to patients carrying triplets is medically reasonable, but whether this is perceived as a valuable option by the patient will depend on many factors, including the family’s social, financial, ethical, and religious considerations.

“Obstetrics: Normal and Problem Pregnancies E-Book” by Steven G. Gabbe, Jennifer R. Niebyl, Joe Leigh Simpson, Mark B Landon, Henry L Galan, Eric R. M. Jauniaux, Deborah A Driscoll, Vincenzo Berghella, William A Grobman
from Obstetrics: Normal and Problem Pregnancies E-Book
by Steven G. Gabbe, Jennifer R. Niebyl, et. al.
Elsevier Health Sciences, 2016

The risk of fetal loss increases with gestational age, so most monochorionic monoamniotic twins are delivered electively at 32 to 34 weeks.

“Cloherty and Stark's Manual of Neonatal Care” by Anne R. Hansen, Eric C. Eichenwald, Ann R. Stark, Camilia R. Martin
from Cloherty and Stark’s Manual of Neonatal Care
by Anne R. Hansen, Eric C. Eichenwald, et. al.
Wolters Kluwer Health, 2016

All multiples are at risk for preterm labor, preterm delivery, gestational diabetes, hypertensive disorders of pregnancy, fetal growth restriction, and cesarean delivery.

“Obstetrics: Normal and Problem Pregnancies E-Book” by Mark B Landon, Henry L Galan, Eric R. M. Jauniaux, Deborah A Driscoll, Vincenzo Berghella, William A Grobman, Sarah J Kilpatrick, Alison G Cahill
from Obstetrics: Normal and Problem Pregnancies E-Book
by Mark B Landon, Henry L Galan, et. al.
Elsevier Health Sciences, 2020

When multiples are delivered, it is best to have a separate resuscitation team planned for each infant.

“Klaus and Fanaroff's Care of the High-Risk Neonate E-Book” by Avroy A. Fanaroff, Jonathan M Fanaroff
from Klaus and Fanaroff’s Care of the High-Risk Neonate E-Book
by Avroy A. Fanaroff, Jonathan M Fanaroff
Elsevier Health Sciences, 2019

Simoes and co-workers showed that pregravid obesity appears to predispose women to gestational diabetes during twin pregnancy and that there is no advantage in terms of birth weight in twins born to diabetic mothers.51 All mothers of multiples are at considerably greater risk of preterm labor and delivery.

“Fanaroff and Martin's Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant” by Richard J. Martin, Avroy A. Fanaroff, Michele C. Walsh
from Fanaroff and Martin’s Neonatal-Perinatal Medicine: Diseases of the Fetus and Infant
by Richard J. Martin, Avroy A. Fanaroff, Michele C. Walsh
Elsevier Health Sciences, 2014

The mother should be reassured that this is not unusual with multiples; in time, a close relationship with the other baby or babies will develop.

“Mayes' Midwifery E-Book” by Sue Macdonald, Gail Johnson
from Mayes’ Midwifery E-Book
by Sue Macdonald, Gail Johnson
Elsevier Health Sciences, 2017

Women with multiples are 13 times likelier to give birth before 32 weeks than women with a singleton.3 Perinatal mortality is increased in the infants from multiple pregnancies because of increased rates of congenital anomalies, growth abnormalities, obstetric complications specific to multiples, and prematurity.

“Fetal and Neonatal Physiology E-Book” by Richard A. Polin, Steven H. Abman, David Rowitch, William E. Benitz
from Fetal and Neonatal Physiology E-Book
by Richard A. Polin, Steven H. Abman, et. al.
Elsevier Health Sciences, 2016

Oktay Kutluk

Kutluk Oktay, MD, FACOG is one of the world's foremost experts in fertility preservation as well as ovarian stimulation and in vitro fertilization for infertility treatments. He developed and performed the world's first ovarian transplantation procedures as well as pioneered new ovarian stimulation protocols for embryo and oocyte freezing for breast and endometrial cancer patients.

Mail: [email protected]
Telephone: +1 (877) 492-3666

Biography: https://medicine.yale.edu/profile/kutluk_oktay/
Bibliography: oktay_bibliography

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  • Those mom and daughter moments with Gemma and Cara. They must be my favourite, having good time together making s’mores and talking. It’s just so cute.

  • Omg congratulations my dear��������❤️always my dream to have twins in future ����❤️much love for y’all. New subscribe let’s support each other��❤️

  • I LOVED this vlog! I swear I smiled the entire time. First, let me say you look ah-mazing! How is it possible you had two babies in your belly just 23 days earlier in this video?? 2nd, those two baby boys are so freakin adorable!!!!! So alert! So tiny and so perfect. I loved when your husband said, I knew I always wanted to be a dad! So happy for you both! I do follow you on Instagram so I know they’ve grown a lot already. So are they identical twins or fraternal? Do they test them to see if their DNA is the same? Or do they just go by how they were situated in the uterus? Just curious! Take care! And don’t forget to eat!

  • congratulations!!!!hello beautiful, sorry for the late reply! your comment went to spam! sure we can support each other. I will subs now hope u too

  • Oh I relate to this I almost died and got an oxygen tank while laboring. But thankful enough to God he saved me. Cute twins you have hello babies ����

  • My daughter had a baby at 29 wks. She thinks she has post traumatic stress disorder from having a nicu baby. He is almost 4 now and does have severe autism from a traumatic birth.

  • Thanks so much for the support even when you’re so busy with those precious babies! I always wanted twins, but no luck!
    What a lucky momma you are!❤️

  • @caitlyn you really give birth to beautiful twins..
    I just saw your comment on my video, I think you delete..
    but no problem… thanks, and yes just started my youtube journey with a makeup channel, and i really need youtuber support like you,
    you are amazing makeup artist i just saw your video, and lot more see, i learn lot from your video, thankyou… again…
    Please support my youtube channel… thankyou

  • Thank you so much for your previous comment! I didn’t get the notification until just recently but i really appreciate it! Congrats omg your birth!!

  • It’s so funny how each of the babies have different happy sounds Reese squeals and Wren she has a quiet growl squeak mix and Royal just has an all boy growl! Their personalities are really showing as they get older!!!

  • oh my goodness caitlyn, congratulations!!!! i cannot begin to imagine how it must have been for you to go through all of this during this time! but both babies look adorable and hope all is well beauty xxxxxxxxxx

  • Same DNA, same personality and same style. How much identical could you guys be? I could watch your channel until your children goes to college. You’re family is so cool and adorable.

  • I love the moments with Darik and Dylan, they look the exact same as adults.. when Dylan had the camera for a minute I thought it was Darik

  • The more I see them, the stronger the baby fever gets and the more my grandmother tells me no more kids ���� so incredibly glad they’re finally home ❤️

  • Babies gotten so big so fast I can’t take it lol!!! Cara you’re amazing! I love how you dress all of your children! Please if you can let us know where you get the bows and outfits

  • Not sure how I misses this?!? But I’d like a million copies of Gemma singing Let it go please LOL!!!! Cara. You are amazing and I absolutely love the way you are with Gemma ❤

  • Cara is a pro. I.was worried about the walk with Gemma and all the munchkins but the sling for the win. Babies adorable and so happy for bathtime. Darik and Dylan, thanks for that ATL accent. I spit my water out when you said that southern Hi walking in restaurant. You all make my day. XOXO ❤

  • The cutest babies,the most handsome twin brothers,the most beautiful mom and wife,the sweetest family,the Chatfam�� Stay blessed y’all.

  • I live for Wrens button nose….they’re all so cute but her nose melts me. You’re so blessed to have so many beautiful and healthy babies.

  • God bless you Cara power momma!!! Gemma ����a delight to watch!! So independent great job Momma and Papa. Twins are always so cheerful and singing!