title: Co-bedding between preterm twins attenuates stress response after heel lance: results of a randomized trial.
abstract: 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 μg/dL (SD 0.25) in the co-bedding group and 0.43 μg/dL (SD 0.50) in the standard care group. Twenty minutes after lance, levels were significantly lower in the co-bedding group, 0.28 μg/dL (SD 0.25) versus 0.50 μg/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 μg/dL) compared with the standard care group (0.14 μg/dL, P<0.05).
  
  
  CONCLUSIONS
  Co-bedding attenuates the stress response of preterm twins undergoing heel lance.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT009176.
authors.affiliation: *Department of Pediatrics, School of Nursing, Dalhousie University and IWK Health Centre, Halifax, NS †School of Nursing, McGill University §Centre for Nursing Research, Jewish General Hospital and The Quebec Interuniversity Nursing Intervention Research Group (GRIISIQ) ¶Division of Neonatology, Sainte-Justine University Hospital and Université du Montréal #Douglas Mental Health University Institute, McGill University, Montréal, QC ‡Department of Obstetrics and Gynaecology, School of Population and Public Health, University of British Columbia and the Children's and Women's Hospital of British Columbia, Vancouver, BC ∥Departments of Pediatrics and Psychology, Centre for Pediatric Pain Research, IWK Health Centre and Dalhousie University, Halifax, NS.
authors.forename: Marsha L
authors.initials: ML
authors.lastname: Campbell-Yeo
authors.forename: C Celeste
authors.initials: CC
authors.lastname: Johnston
authors.forename: K S
authors.initials: KS
authors.lastname: Joseph
authors.forename: Nancy
authors.initials: N
authors.lastname: Feeley
authors.forename: Christine T
authors.initials: CT
authors.lastname: Chambers
authors.forename: Keith J
authors.initials: KJ
authors.lastname: Barrington
authors.forename: Claire-Dominique
authors.initials: CD
authors.lastname: Walker
mesh_terms: D001800:Blood Specimen Collection / Q000009:adverse effects*; D005260:Female; D005865:Gestational Age; D006365:Heel; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D007223:Infant; D007224:Infant Care; D008297:Male; D047928:Premature Birth / Q000097:blood*; D012189:Retrospective Studies; D012463:Saliva / Q000378:metabolism; D018709:Statistics, Nonparametric; D013315:Stress, Psychological / Q000209:etiology* / Q000378:metabolism / Q000451:nursing*
chemical_list: D006854:Hydrocortisone