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

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.