Effect of cobedding twins on coregulation, infant state, and twin safety

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.

Using complexity science to understand the role of co-sleeping (bedsharing) in mother-infant co-regulatory processes

Human infants spend most of their time sleeping, but over the first few years of life their sleep becomes regulated to coincide more closely with adult sleep (Galland et al., 2012; Paavonen et al., 2020). Evidence shows that co-sleeping played a role in the evolution of infant sleep regulation, as it is part of an ancient behavioral complex representing the biopsychosocial microenvironment in which human infants co-evolved with their mothers through millions of years of human history (Ball, 2003; McKenna 1986, 1990). This paper is a conceptual, interdisciplinary, integration of the literature on mother-infant co-sleeping and other mother-infant co-regulatory processes from an evolutionary (biological) perspective, using complexity science. Viewing the mother-infant dyad as a "complex adaptive system" (CAS) shows how the CAS fits assumptions of regulatory processes and reveals the role of the CAS in the ontogeny of mother-infant co-regulation of physiological (thermoregulation, breathing, circadian rhythm coordination, nighttime synchrony, and heart rate variability) and socioemotional (attachment and cortisol activity) development.

Contactless radar-based breathing monitoring of premature infants in the neonatal intensive care unit

Vital sign monitoring systems are essential in the care of hospitalized neonates. Due to the immaturity of their organs and immune system, premature infants require continuous monitoring of their vital parameters and sensors need to be directly attached to their fragile skin. Besides mobility restrictions and stress, these sensors often cause skin irritation and may lead to pressure necrosis. In this work, we show that a contactless radar-based approach is viable for breathing monitoring in the Neonatal intensive care unit (NICU). For the first time, different scenarios common to the NICU daily routine are investigated, and the challenges of monitoring in a real clinical setup are addressed through different contributions in the signal processing framework. Rather than just discarding measurements under strong interference, we present a novel random body movement mitigation technique based on the time-frequency decomposition of the recovered signal. In addition, we propose a simple and accurate frequency estimator which explores the harmonic structure of the breathing signal. As a result, the proposed radar-based solution is able to provide reliable breathing frequency estimation, which is close to the reference cabled device values most of the time. Our findings shed light on the strengths and limitations of this technology and lay the foundation for future studies toward a completely contactless solution for vital signs monitoring.

Effects of maternal mental health on prenatal movement profiles in twins and singletons

AIM

Prenatal experiences, including maternal stress, depression and anxiety, form crucial building blocks affecting the maturation of the foetal central nervous system. Previous research has examined foetal movements without considering effects of maternal mental health factors critical for healthy foetal development. The aim of this research is to assess the effects of maternal mental health factors on foetal twin compared with singleton movement profiles.

METHOD

We coded foetal touch and head movements in 56 ultrasound scans, from a prospective opportunity sample of 30 mothers with a healthy pregnancy (mean gestational age 27.8 weeks for singleton and 27.2 for twins). At the ultrasound scan appointment, participants completed questionnaires assessing their stress, depression and anxiety.

RESULTS

Maternal depression increased foetal self-touch significantly. In foetal twins, maternal stress significantly decreased and maternal depression significantly increased other twin touch. Maternal mental health factors affected the head movements of twins significantly more than singletons, with maternal depression decreasing head movement frequency for twins significantly.

CONCLUSION

These results indicate that maternal mental health might have an impact on types of body schemata formed in utero, in twin compared with singleton pregnancies. Future research needs to examine whether these prenatal effects affect postnatal differences in body awareness.

Early Psychomotor Advantage in Moderately Preterm Twins Born between 32 and 33 Weeks

Twin birth may represent a challenging event often associated with prematurity. We previously reported on developmental trajectories in preterm children categorized by gestational age. Based on the same study population, in this study we investigated the influence of gemellarity on the neurodevelopment of 73 twins (26.4%) and 207 singletons (73.6%), categorized into three groups according to their gestational age. The age of the achievement of developmental milestones between the three groups and the influence of preperinatal events on neurodevelopment were analyzed. An early neurodevelopmental advantage was detected in preterm twins born between 32 and 33 weeks. Environmental and nurturing factors may explain these findings.