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Co-bedding Between Preterm Twins Attenuates Stress Response After Heel Lance: Results of a Randomized Trial

Objective:To examine the effect of co-bedding between preterm twins on stress response after heel lance. Methods:Using a multisite randomized controlled trial design, stable preterm twins (67 sets, N=134 infants) between 28 and 36 completed weeks’ gestational age, stratified by gestational age (⩽ and >32 weeks) and site, were randomly assigned to a co-bedding group, cared for continuously in the same incubator or crib or a standard care group, cared for in a separate incubator or crib, and underwent a medically indicated heel lance after at least 24 hours and no greater than 10 days of group allocation. The reported outcome was cortisol from saliva samples from 89 twins (n=49 co-bedding, n=40 standard care) collected immediately before the heel lance (baseline levels) and 113 twins (n=58 co-bedding, n=55 standard care) collected 20 minutes after heel lance (stress levels) as an index of stress response. Results:No group differences were noted in baseline salivary cortisol levels: 0.36 &mgr;g/dL (SD 0.25) in the co-bedding group and 0.43 &mgr;g/dL (SD 0.50) in the standard care group. Twenty minutes after lance, levels were significantly lower in the co-bedding group, 0.28 &mgr;g/dL (SD 0.25) versus 0.50 &mgr;g/dL (SD 0.73) in the standard group (P=0.04). Similarly, the mean of paired changes in salivary cortisol from baseline was lower in the co-bedding group (−0.06 &mgr;g/dL) compared with the standard care group (0.14 &mgr;g/dL, P<0.05). Discussion:Co-bedding attenuates the stress response of preterm twins undergoing heel lance. Trial Registration:clinicaltrials.gov Identifier: NCT009176.