Related Experiment Video
Updated: May 5, 2026
Author Spotlight: Exploring Microglial Interactions with Stress-Response Circuitry Using the Limited Bedding and Nesting Model
Published on: July 12, 2024
Co-bedding between preterm twins attenuates stress response after heel lance: results of a randomized trial
Marsha L Campbell-Yeo1, C Celeste Johnston, K S Joseph
1*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.
Insights
Co-bedding preterm twins significantly reduces their stress response to heel lance procedures. This finding suggests co-bedding is an effective intervention for managing pain and stress in vulnerable infants.
Area of Science:
- Neonatal care
- Pediatric endocrinology
- Infant psychology
Background:
- Preterm infants experience significant stress during common medical procedures like heel lance.
- Previous research indicates that skin-to-skin contact can reduce physiological stress markers in infants.
- The specific impact of co-bedding on stress response in preterm twins remains an area requiring further investigation.
Purpose of the Study:
- To investigate the effect of co-bedding on the physiological stress response of preterm twins undergoing heel lance.
- To compare salivary cortisol levels as a biomarker of stress between preterm twins who are co-bedded and those receiving standard separate care.
Main Methods:
- A multisite randomized controlled trial involved 134 stable preterm twins (28-36 weeks gestational age).
- Infants were stratified by gestational age and randomly assigned to either a co-bedding group or standard separate care.
- Salivary cortisol levels were measured immediately before and 20 minutes after a medically indicated heel lance.
Main Results:
- No significant differences in baseline salivary cortisol levels were observed between the groups.
- Twenty minutes post-heel lance, salivary cortisol levels were significantly lower in the co-bedding group compared to the standard care group (P=0.04).
- The mean change in salivary cortisol from baseline was also significantly lower in the co-bedding group (P<0.05).
Conclusions:
- Co-bedding effectively attenuates the acute stress response in preterm twins following heel lance.
- These findings support the implementation of co-bedding as a non-pharmacological intervention to improve pain and stress management in preterm twins.
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).
Discussion:
Co-bedding attenuates the stress response of preterm twins undergoing heel lance.
Trial Registration:
clinicaltrials.gov Identifier: NCT009176.
