Comfort care plan to periviable infants: associated decision reversals and missed opportunity of antenatal steroids

Abstract

Objective

This study aims to identify how often families of periviable infants had a care plan stating whether to provide active or comfort care and how often the care plan was reversed, close to or after the delivery.

Study design

In this retrospective study, we reviewed the medical records of all mother-infant dyads (single or twin infants with no known congenital anomalies) who were delivered between 23 0/7 and 24 6/7 weeks gestational age from January 2012 to December 2016.

Result

Ninety-nine women met the inclusion criteria − 6 (6%) did not have a care plan available, 85 women (86%) chose for active care and received antenatal steroids (ANS). Six women (6%) who chose comfort care and two women (2%) who chose limited resuscitation during antenatal counseling opted out of the ANS. Two thirds of the women (4/6) who initially opted for comfort care later desired active care, while none of the women who chose active care reversed their decisions.

Conclusion

The majorities of the families (94%) had a prenatal care plan in place. Two-thirds (4/6) of the families who opted for comfort care changed their decisions resulting in a missed opportunity for ANS.

Keywords:

• Prenatal counseling
• antenatal steroids
• active care
• comfort care
• decision reversals

Disclosure statement

No potential conflict of interest was reported by the author.