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Co-bedding Between Preterm Twins Attenuates Stress Response After Heel Lance: Results of a Randomized Trial

Campbell-Yeo, Marsha L. PhD, RN*,†; Johnston, C. Celeste DEd, RN; Joseph, K. S. PhD, MD; Feeley, Nancy PhD, RN†,§; Chambers, Christine T. PhD; Barrington, Keith J. MD; Walker, Claire-Dominique PhD#

The Clinical Journal of Pain: July 2014 - Volume 30 - Issue 7 - p 598–604
doi: 10.1097/AJP.0000000000000015
Original Articles

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: Identifier: NCT009176.

*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

Clinical Trials Registry NCT00917631.

Partnered funding for this study was obtained from the Groupe de Recherche Interuniversitaire en Interventions en Sciences Infirmieres du Quebec (GRIISIQ), Montreal, Canada, the Canadian Nurses Foundation Nursing Care Partnership Program Ottawa, Canada, Canadian Institutes of Health Research (CIHR), Ottawa, Canada, and the IWK Health Centre, Halifax, Canada. M.L.C.-Y. is supported by a Clinical Initiative Fellowship from the Canadian Institutes of Health Research, and has received doctoral fellowship support from the Nova Scotia Health Research Foundation, Halifax, Canada, and the Canadian Nurses Foundation, Ottawa, Canada. K.S.J. is supported by a salary award from the Child and Family Research Institute, Vancouver, Canada. N.F. is supported by a Clinical Research Scholar award from the Quebec Health Research Fund (FRSQ), Montreal, Canada. C.T.C. is supported by a Canada Research Chair, Halifax, Canada. The authors declare no conflict of interest

Reprints: Marsha L. Campbell-Yeo, PhD, RN, IWK Health Centre, NICU, 5850/5980 University Avenue, P.O. Box 9700, Halifax, Nova Scotia, Canada B3K 6R8 (e-mail:

Received December 20, 2012

Accepted August 2, 2013

© 2014 by Lippincott Williams & Wilkins