Co-bedding in neonatal nursery for promoting growth and neurodevelopment in stable preterm twins

Interventions for reducing late-onset sepsis in neonates: an umbrella review

OBJECTIVES

Neonatal sepsis is one of the leading causes of neonatal deaths in neonatal intensive care units. Hence, it is essential to review the evidence from systematic reviews on interventions for reducing late-onset sepsis (LOS) in neonates.

METHODS

PubMed and the Cochrane Central were searched from inception through August 2020 without any language restriction. Cochrane reviews of randomized clinical trials (RCTs) assessing any intervention in the neonatal period and including one or more RCTs reporting LOS. Two authors independently performed screening, data extraction, assessed the quality of evidence using Cochrane Grading of Recommendations Assessment, Development and Evaluation, and assessed the quality of reviews using a measurement tool to assess of multiple systematic reviews 2 tool.

RESULTS

A total of 101 high-quality Cochrane reviews involving 612 RCTs and 193,713 neonates, evaluating 141 interventions were included. High-quality evidence showed a reduction in any or culture-proven LOS using antibiotic lock therapy for neonates with central venous catheters (CVC). Moderate-quality evidence showed a decrease in any LOS with antibiotic prophylaxis or vancomycin prophylaxis for neonates with CVC, chlorhexidine for skin or cord care, and kangaroo care for low birth weight babies. Similarly, moderate-quality evidence showed reduced culture-proven LOS with intravenous immunoglobulin prophylaxis for preterm infants and probiotic supplementation for very low birth weight (VLBW) infants. Lastly, moderate-quality evidence showed a reduction in fungal LOS with the use of systemic antifungal prophylaxis in VLBW infants.

CONCLUSIONS

The overview summarizes the evidence from the Cochrane reviews assessing interventions for reducing LOS in neonates, and can be utilized by clinicians, researchers, policymakers, and consumers for decision-making and translating evidence into clinical practice.

Integrative Review of Cobedding of Infant Twins

OBJECTIVE

To synthesize the evidence on the benefits and risks of cobedding for infant twins and to assess the perceptions and practices of parents and health care workers regarding this practice.

DATA SOURCES

We searched the following databases for articles published between 1997 and 2022: CINAHL, Cochrane, Ovid MEDLINE, PubMed, Scopus, and Google Scholar.

STUDY SELECTION

We included full-text articles published in English in which the authors addressed twin cobedding in hospital or home settings. We reviewed the abstracts of 106 articles and retained 54 for full-text review. Of these, 18 met eligibility criteria and were included in the review.

DATA EXTRACTION

We extracted the following data: author(s), year of publication, setting, purpose, study design, sample characteristics, methodologic details, outcomes and findings, and limitations. We appraised the quality of each study.

DATA SYNTHESIS

In the included articles, researchers identified no differences in apnea, heart rate, or oxygen saturation between cobedded and separately bedded infants. Compared to separately bedded infants, cobedded infants had greater weight gain and synchronization of sleep-wake states. Researchers found benefits for procedural pain relief and recovery after heel lance among cobedded infants. Researchers report that many parents are choosing to cobed their twins, but we found limited qualitative data exploring parents' perceptions or practices. In the included articles, nurses had positive perceptions of twin cobedding. Overall, the quality of evidence was low because of inconsistencies in study methods and small sample sizes that resulted in imprecise results.

CONCLUSION

We found potential benefits and no evidence of harm related to cobedding of twin infants. However, the evidence was insufficient to provide recommendations for practice, and additional research is warranted.

Co-bedding of Preterm Newborn Pigs Reduces Necrotizing Enterocolitis Incidence Independent of Vital Functions and Cortisol Levels

Background: Preterm infants are born with immature organs, leading to morbidities such as necrotizing enterocolitis (NEC), a gut inflammatory disease associated with adverse feeding responses but also hemodynamic and respiratory instability. Skin-to-skin contact including "kangaroo care" may improve infant survival and health via improved vital functions (e.g., pulmonary, cardiovascular) and endocrine influences by adrenal glucocorticoids. Clinical effects of skin-to-skin contact for newborn siblings ("co-bedding") are not known. Using NEC-susceptible Preterm pigs as models, we hypothesized that co-bedding and exogenous glucocorticoids improve vital functions and NEC resistance. Methods: In experiment 1, cesarean-delivered, formula-fed Preterm pigs were reared in incubators with (co-bedding, COB, n = 30) or without (single-bedding, SIN, n = 29) a sibling until euthanasia and tissue collection on day four. In experiment 2, single-bedded Preterm pigs were treated postnatally with a tapering dose of hydrocortisone (HC, n = 19, 1-3 mg/kg/d) or saline (CON, n = 19). Results: Co-bedding reduced NEC incidence (38 vs. 65%, p < 0.05) and increased the density of colonic goblet cells (+20%, p < 0.05) but had no effect on pulmonary and cardiovascular functions (respiration, blood pressure, heart rate, blood gases) or cortisol levels. There were limited differences in intestinal villous architecture and digestive enzyme activities. In experiment 2, HC treatment increased NEC lesions in the small intestine without any effects on pulmonary or cardiovascular functions. Conclusion: Co-bedding may improve gut function and NEC resistance independently of cardiorespiratory function and cortisol levels, but pharmacological cortisol treatment predispose to NEC. Preterm pigs may be a useful tool to better understand the physiological effects of co-bedding, neonatal stressors and their possible interactions with morbidities in Preterm neonates.