title: [Terminal ill children and dnd-of-life practices in the pediatric intensive care units].
abstract: OBJECTIVE
  To analyze and discuss the medical practices related to the end-of-life care provided to children admitted to pediatric intensive care unit (PICU) in Brazil and in some countries located in the northern hemisphere.
  
  
  BACKGROUND
  Selected articles on end-of-life care published during the last years searching the PubMed, MedLine and LILACS database, with special interest on studies of death conducted in pediatric intensive care units in Brazil, Latin America, Europe and North America, using the following key words: death, bioethics, PICU, cardiopulmonary resuscitation and life support limitation (LSL).
  
  
  CONCLUSIONS
  In North America and North Europe, the incidence of LSL is greater (60%-80%) than in south Europe and Latin America (30%-40%). In Brazil the incidence of LSL depends on the region and in the last decade it is increasing from 6% to 40%; being the do-not-reanimated order the most frequent mode of LSL. The family participation in the decision making process is not stimulated and incipient. Based on the literature review and on their experience the authors present the measures that they consider most efficient and recommended for managing this situation in our region. Despite of LSL in children with terminal and irreversible disease be considered ethically, morally and legally; these measures are still adopted in a very few circumstances in our region. Urgent changes in this behavior are necessary, specially related to family participation in the decision-making process.
authors.affiliation: Hospital de Clinicas de Porto Alegre.
authors.forename: Patrícia Miranda
authors.initials: PM
authors.lastname: Lago
authors.affiliation: Dept Critical Care, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canadá
authors.forename: Daniel
authors.initials: D
authors.lastname: Garros
authors.affiliation: Departamento de Pediatria, PUCRS.
authors.forename: Jefferson P
authors.initials: JP
authors.lastname: Piva