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We recently had a debate in our unit about whether or not it was better for a well twin to remain with its sibling in hospital until the latter was fit to be discharged. Our current practice is to keep the well twin in the special care baby unit until its twin is fit for discharge. The group who favoured separate discharge cited reduced risk of nosocomial infection, decreased costs, cot availability, and the possibility of settling into a routine with one twin at home as supportive factors for their argument. Those against separate discharge cited impaired bonding, breast feeding difficulties, and transport issues as their reasons.
We took the discussion to the RCPCH and NICU-net email discussion groups and found no clear consensus. Our American colleagues routinely send multiples home separately and cite health insurance companies as a major factor in this decision. They find little problem with this arrangement. European opinion was split between the two camps. British doctors seemed to be in favour of asking the parents’ opinion, so we identified 10 sets of twins from the last three years who could have been sent home separately. We then sent their parents a questionnaire exploring their opinions; five (50%) were returned.
Most parents agreed that their twins were ready for discharge at different times and said that they would have preferred separate discharge. However, they believed that they had been given this option and had not taken it. They realise that this would have caused problems with visiting, feeding, and bonding with the remaining twin even although they all had their own transport. They did not think that having one twin home first would have helped them to adjust and settle into a routine. Their preferred option would have been to have roomed in with the well twin while the other twin stayed on the special care baby unit.
Our current practice is that we have an informed discussion with the parents when this situation arises. As one email respondent (a doctor and father of twins) wrote “Bringing up twins is full of decisions about when to pair them and when to split them up.”