Randomised controlled trial shows that co‐bedding twins may reduce birthweight recovery delay, parenteral nutrition weaning time and hospitalisation

INTRODUCTION Multiple pregnancies have been increasing, due to advances in assisted reproductive technology and delayed childbearing (1), and adapting and optimising medical protocols for multiple births have become a priority (2). In utero ultrasound has highlighted remarkable social bonds between twins, including the similarity of heart rates, sleep and wake rhythms and early behavioural interactions (3). The co-bedding technique is in line with the co-regulation and synactive theories, where the goal is to provide developmental and health benefits to twins (4,5). Cobedding essentially prolongs the behavioural bond and in utero interactive development between twins and may significantly reduce postnatal stress due to separation. Although the technique is now widely employed (6), cobedding was traditionally performed late in hospitalisation, which was questionable given its objective to reduce separation stress at a critical clinical stage. We believe that early co-bedding, as soon as possible after birth, may be of critical importance. To date, there has been a lack of consensus among studies and a paucity of compelling data on the potential clinical benefits of co-bedding (7). Lai et al.’s database analysis in 2012 pinpointed discrepancies in the data produced by co-bedding studies, as well as the absence of data and safety and long-term outcomes (8). Heterogeneous practices, clinical judgement criteria and, most importantly, the delayed co-bedding of stable newborn twins several weeks after birth, may have contributed to this lack of clarity (6,9–12). We decided to assess the effects of early co-bedding just after birth on twins ventilated with continuous positive airway pressure. We primarily focused on weight gain, but also considered thermoregulation, cardiorespiratory function, comfort and long-term neurodevelopmental outcomes at two years of age. Neonatology and Cobedding (NEOCOB) was a monocentric prospective study using a randomised unblinded protocol and approved by the Medical Ethics Committee of Nantes, France.Weplanned to co-bedall twins bornbetween 30 and 34 weeks of gestation, who did not have severe congenital pathologies but needed intubation, in the first 24 hours following birth. If intubated ventilated preterm infants were not eligible for practical reasons, due to the organisation of our unit, noninvasive ventilation support such as continuous positive airway pressure was accepted. Because intrauterine growth restriction (IUGR) has a significant impact on neonatal weight gain, the block randomisation was stratified by whether one or both of the twins were IUGR, in accordance with the usual Fenton curves. Parental consent was requested as soon as possible after birth, and initial resuscitation and randomisation were performed immediately by the hospital’s Women’s and Children’s Clinical InvestigationCenter todetermine the treatment arm. Abbreviations ANOVA, ANalysis Of VAriance; IUGR, IntraUterin Growth Restriction; LoS, Length of Stay; NEOCOB, NEOnatology & CO-Bedding; NICU, Neonatal Intensive Care Unit.