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Updated: Nov 9, 2025
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Bed sharing versus no bed sharing for healthy term neonates
Rashmi R Das1, Mari Jeeva Sankar2, Ramesh Agarwal2
1Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, India.
Insights
This review found no studies evaluating the safety and efficacy of bed sharing for newborns. Further research is needed to understand the benefits and risks of infant bed sharing practices.
Area of Science:
- Neonatal care
- Infant sleep practices
- Public health
Background:
- Global variations exist in infant sleeping arrangements, with bed sharing being a common practice.
- Bed sharing may offer physiological benefits like improved cardiopulmonary stability and breastfeeding duration.
- However, bed sharing is associated with an increased risk of sudden infant death syndrome (SIDS).
Purpose of the Study:
- To assess the efficacy and safety of neonatal bed sharing.
- To evaluate impacts on breastfeeding, SIDS incidence, hypothermia, mortality, and neurodevelopmental outcomes.
Main Methods:
- Searched multiple databases (CENTRAL, PubMed, CINAHL, LILACS) for randomized controlled trials (RCTs) and quasi-RCTs.
- Included studies on term neonates sharing a bed with their mother within 24 hours of birth.
- Planned to use the GRADE approach for evidence certainty assessment.
Main Results:
- A comprehensive search yielded 6231 records, with 2745 records screened after duplicate removal.
- Six full-text studies were assessed but ultimately excluded as they did not meet eligibility criteria.
- No studies met the inclusion criteria for this review.
Conclusions:
- No eligible studies were found to evaluate the efficacy and safety of bed sharing in healthy term neonates.
- There is a critical need for well-designed RCTs to assess outcomes like breastfeeding and SIDS risk.
- Future research should include diverse populations and settings, particularly in regions where bed sharing is culturally prevalent.
Background:
There is great global variation in the sleeping arrangements for healthy newborn infants. Bed sharing is a type of sleeping practice in which the sleeping surface (e.g. bed, couch or armchair, or some other sleeping surface) is shared between the infant and another person. The possible physiological benefits include better oxygen and cardiopulmonary stability, fewer crying episodes, less risk of hypothermia, and a longer duration of breastfeeding. On the other hand, the most important harmful effect of bed sharing is that it may increase the risk of sudden infant death syndrome (SIDS). Studies have found conflicting evidence regarding the safety and efficacy of bed sharing during infancy.
Objectives:
To evaluate the efficacy and safety of bed sharing, started during the neonatal period, on breastfeeding status (exclusive and total duration of breastfeeding), incidence of SIDS, rates of hypothermia, neonatal and infant mortality, and long-term neurodevelopmental outcomes.
Search Methods:
We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2020, Issue 7) in the Cochrane Library; MEDLINE via PubMed (1966 to 23 July 2020), CINAHL (1982 to 23 July 2020), and LILACS (1980 to 23 July 2020). We also searched clinical trials databases, and the reference lists of retrieved articles, for randomised controlled trials (RCTs) and quasi-RCTS.
Selection Criteria:
We planned to include RCTs or quasi-RCTs (including cluster-randomised trials) that included term neonates initiated on bed sharing within 24 hours of birth (and continuing to bed share with the mother in the first four weeks of life, followed by a variable time period thereafter), and compared them to a 'no bed sharing' group.
Data Collection And Analysis:
We used standard methodological procedures as recommended by Cochrane. We planned to use the GRADE approach to assess the certainty of evidence.
Main Results:
Our search strategy yielded 6231 records. After removal of duplicate records, we screened 2745 records by title and abstract. We excluded 2739 records that did not match our inclusion criteria. We obtained six full-text studies for assessment. These six studies did not meet the eligibility criteria and were excluded.
Authors' Conclusions:
We did not find any studies that met our inclusion criteria. There is a need for RCTs on bed sharing in healthy term neonates that directly assess efficacy (i.e. studies in a controlled setting, like hospital) or effectiveness (i.e. studies conducted in community or home settings) and safety. Future studies should assess outcomes such as breastfeeding status and risk of SIDS. They should also include neonates from high-income countries and low- and middle-income countries, especially those countries where bed sharing is more prevalent because of cultural practices (e.g. Asian countries).
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