Is bed sharing an effective and safe method in the care of healthy term neonates?

Review question: we wanted to find out if bed sharing is associated with an increase in the duration and frequency of breastfeeding in babies who are born after 37 weeks of pregnancy (also known as term neonates) and are healthy at birth.

Background: '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 reasons that families choose to bed share include: ease in breastfeeding; temperature regulation (avoidance of hypothermia); spending quality time with the infant; helping the infant sleep and being able to easily comfort the infant in case they become agitated; being able to attend to them quickly in case of any mishap; providing close care during an illness; and promotion of bonding. However, for many families worldwide, the practice of bed sharing is not a choice. In high-income countries, bed sharing is regarded as a controversial practice, and has drawn special attention with regard to its role in sudden infant death syndrome (SIDS). But in low- and middle-income countries, bed sharing has been the standard practice for many groups who could not afford different sleeping surfaces. In these less rich societies, bed sharing is believed to contribute to: longer durations of breastfeeding; increased time and duration of infant arousals; decreased time and duration spent in deep sleep; and increases in the mother’s awareness of the infant's condition.

Study characteristics: we searched for studies up to 23 July 2020. The aim of the review was to include randomised controlled studies (RCTS). RCTs are clinical studies where participants are randomly put into one of two or more treatment groups. We planned to include RCTs of term neonates who started to bed share with the mother within 24 hours of birth (and continued to bed share with the mother in the first four weeks of life, followed by a variable time period after). We aimed to compare a 'bed sharing' group to a 'no bed sharing' group. During bed sharing, there is close contact between the mother and infant. The possible physiological benefits include better temperature regulation with less risk of hypothermia, and a longer duration of successful breastfeeding. The harms include sudden infant death as a result of the mother lying on the infant, and use of pillows and comforters.

Key results: we assessed six studies for inclusion in this review. We excluded them for the following reasons: secondary data analysis of primary RCTs (two studies); did not study bed sharing (two studies); not a RCT (one study); and outcomes of interest to the review not studied (one study).

Certainty of evidence: we were unable to judge the certainty of the evidence on bed sharing in healthy term neonates. This is because there were no eligible included studies. 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. They should also include infants from high-income countries and low- and middle-income countries, especially those countries where bed sharing is more common because of cultural practices (e.g. Asian countries).

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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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 strategy: 

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.

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