Continuity of Intrauterine Interaction in Extrauterine Life Among Premature Twin Infants: A Review of the Cobeddding Approach

Öz

Most twin pregnancies result in preterm birth, and due to the admission of premature twins to neonatal intensive care units (NICUs), separation often occurs immediately after delivery. This study aims to review recent research on the practice of cobedding, which seeks to replicate the intrauterine environment by allowing physical contact between twin neonates, thereby preventing the abrupt discontinuation of intrauterine stimuli. The reviewed studies are limited to neonatal intensive care settings and premature twin infants. According to the limited literature, cobedding—particularly in stable premature twins—has been shown to contribute to increased body weight, stabilization of heart rate and oxygen saturation following painful procedures, reduction in pain scores, crying duration, and salivary cortisol levels (a biomarker of stress response), as well as an increase in non-REM sleep duration. Although no adverse effects of cobedding have been reported in stable premature twins, the evidence supporting its potential benefits remains limited. Conducting controlled, evidence-based multicenter studies and developing standardized protocols—while carefully considering the risks of infection and sudden infant death—may contribute to care approaches.

Anahtar Kelimeler

• premature
• twin
• cobedding
• NICU

Prematire İkiz Bebeklerde İntrauterin Etkileşimin Ekstrauterin Yaşamda Devamlılığı: Cobedding Yaklaşımına İlişkin İnceleme

Öz

İkiz gebeliklerin çoğu erken doğumla sonuçlanmakta ve prematüre ikizler yenidoğan yoğun bakıma alınması nedeniyle doğumdan hemen sonra ayrılmaktadır. Bu çalışmada, ikiz yenidoğanların birbirlerine fiziksel temas ile intrauterin ortamı taklit etmelerini sağlayarak intrauterin dönemdeki uyarının aniden ortadan kaldırılmasını önlemeyi hedefleyen cobedding uygulamasına yönelik son yıllarda yapılan çalışmaların incelenmesi amaçlanmıştır. Çalışmalar yenidoğan yoğun bakım ve prematüre ikizlerle sınırlandırılmıştır. Sınırlı literatür sonucuna göre; cobedding uygulamasının özellikle stabil prematüre ikizlerde vücut ağırlığında artışa, ağrılı girişim sonrası kalp atım hızının, oksijen satürasyonunun, ağrı skorunun, ağlama süresinin ve stres yanıtının belirleyicisi olan tükrük kortizol düzeyinin azalmasına, non-REM uyku süresinin artmasına etki ettiği görülmüştür. Stabil prematüre ikizlerde cobedding uygulamasının bildirilen olumsuz etkisi olmamasına karşın, potansiyel faydalarına yönelik ortaya çıkan kanıtlar da sınırlı sayıdadır. Enfeksiyon ve ani bebek ölüm riski gözardı edilmeden kontrollü şekilde kanıta dayalı çok merkezli çalışmaların gerçekleştirilmesi ve protokollerin geliştirilmesi bakım yaklaşımlarına katkı sağlayabilir.

Anahtar Kelimeler

• prematüre
• ikiz
• birlikte yatırma
• YYBÜ

Kaynakça

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