Os profissionais que acompanham a saúde e desenvolvimento criança de forma sistemática nos primeiros aos de vida, são fundamentais no processo de aquisição e desenvolvimento da linguagem. Este estudo teve por objetivo desenvolver e analisar um ambiente virtual de aprendizagem, na área de Fonoaudiologia, aquisição e desenvolvimento da linguagem infantil para orientação dos médicos pediatras, com a utilização da Teleducação Interativa. A metodologia seguiu as seguintes fases de desenvolvimento: Análise e Planejamento, Modelagem, Implementação e Avaliação. Foi realizada uma ampla revisão de literatura sobre as etapas de desenvolvimento da linguagem, de forma cronológica, desde o nascimento até os 7 anos de idade, indicando as principais características e os marcos do desenvolvimento em cada fase, para confecção do material a ser implementado no ambiente virtual de aprendizagem em formato de blog. O material desenvolvido foi disponibilizado no endereço eletrônico http://fonoaudiologiaparapediatras.wordpress.com./. Este material foi avaliado do ponto de vista da qualidade técnica e do conteúdo por 63 fonoaudiólogos por meio de dois questionários, sendo o primeiro denominado de Emory adaptado e o segundo correspondendo à avaliação específica do conteúdo do blog elaborado pela pesquisadora. Os resultados demonstraram que o blog foi avaliado como Excelente quanto aos aspectos: conteúdo, precisão, autoria, atualizações, público, navegação, links externos e estrutura, bem como na avaliação específica do conteúdo. Outro ponto favorável foi o alcance do material, no período de setembro a dezembro de 2012 o blog Fonoaudiologia e Pediatria recebeu 5.046 visitas de diversos países, além do Brasil, demonstrando o uso frequente da internet para obtenção de informações na área da saúde. Portanto, um ambiente virtual de aprendizagem contendo informações sobre a aquisição e desenvolvimento da linguagem foi desenvolvido, a fim de orientar médicos pediatras englobando desde fases típicas a alterações, prevenção, fases do desenvolvimento e possíveis encaminhamentos. / Professinals who accompanying the child health and development systematically in the early years of his life, are fundamental in process of language acquisition and development. The present study aimed to develop and analyze an electronic media material in the field of speech pathology focusing on childish development and acquisition language to guide pediatric doctors, using the Interactive Tele-education. The methodology follows the following stages of development: Planning and Analysis, Modelling, Implementation and Evaluation. Was performed wide a literature review about the stages of language development, chronologically, from birth until the age of 7, pointing out the main characteristics and developmental marks at each stage, for preparing the material to be implemented in the virtual learning environment in blog format. The material made is available on the electronic address http://fonoaudiologiaparapediatras.wordpress.com/. This material was evaluated in terms of technical quality and content by 63 speech therapists through two questionnaires, the first one is an adaptation of Emory and the second one corresponding to the specific evaluation of the blog content, prepared by the researcher. The results demonstrated that the blog has been rated as \"Excellent\" on the aspects: content, accuracy, authorship, updates, public, navigation, external links and structure, as well as in the specific content evaluation. Another favorable point was the scope of the material, from September to December 2012 the blog \"Speech Pathology and Pediatrics\" received 5.046 visits from several countries, besides the Brazil, demonstrating the frequent use of internet to obtain information on health. Thereby, a virtual learning environment, in blog format, containing information on the acquisition and development of language was developed to guide pediatric doctors from typical phases subject to changes, prevention, stages of development and possible referrals.

Background: The relationship between interpersonal trauma (IPT) and substance misuse is complex and multi-factorial, but has not been examined fully in the existing few studies involving pregnant women who misuse substances. UK based midwifery education and practice is unique, but there is limited evidence regarding midwives experiences and perceptions of supporting this client group. Aims: The aim of this study was to chronologically map out pregnant women's past experiences of abuse and substance use, explore their experiences and perceptions of their journey to motherhood and explore midwives' experiences and perceptions of supporting this client group. Methods: A qualitative study was conducted. Five eligible pregnant women supported by specialist midwifery services in Central Scotland were recruited. Data were collected using a life history calendar (LHC), followed by an in-depth, semi-structured interview. Six eligible midwives were recruited from one NHS board in Central Scotland. In depth, semi-structured interviews were carried out. Findings: Individual LHCs were converted into chronological timelines. Transcribed interviews were analysed using Interpretative Phenomenological Analysis. The life history calendars revealed the pregnant participants' experiences of IPT and substance misuse as complex, interconnected and ongoing, including during pregnancy and motherhood. Three major overarching themes emerged from the pregnant participants' interview transcripts: “psychological trauma”, “dabbling to addiction” and “addiction and the identity of pregnancy and motherhood”. Three major overarching themes emerged from the midwifery participants' interview transcripts: “psychological trauma”, “stigma” and “managing unmanageable situations”. Conclusions: This study sheds new light on the lived experiences and perceptions of a previously under-researched and largely misunderstood group of vulnerable women. It highlights some of the challenges faced by midwives in clinical practice. Important areas for future research are highlighted, along with implications for multi-disciplinary education, policy and practice.

Very severe maternal obesity (BMI > 40kg/m2) increases significantly the risks of poor pregnancy outcomes for both mothers and babies. In light of the limited success of behavioural interventions to date in improving outcomes in very severely obese women, this study sought to gain an understanding of women's beliefs and experiences regarding weight, health and pregnancy, within the context of their everyday lives. Qualitative serial interviews were conducted with eleven very severely obese women during pregnancy and the postnatal period. Seven partners of the women took part in one semi-structured interview during the woman's pregnancy. Analysis took place in several stages using a thematic approach. Themes were identified within and between individual women's accounts, as well as within and between the accounts of members of couples. Participants' narratives demonstrated the ways in which they navigated the experience of high-risk pregnancy, and stigma emerged as a key theme. This research contributes new knowledge about the complex ways in which women experience ‘very severe obese' pregnant embodiment, relating to both formal and informal discourses around weight and health in pregnancy. Most undertook ‘moral accounting' in response to stigma, and several accounts resonated with Monaghan's (2006) categorisations of excuses, justifications, contrition and repudiation, in both accounting for their weight and in demonstrating their ‘fitness' for pregnancy and motherhood. Following birth, high levels of motivation to enact behaviour change were expressed, in some cases alongside repudiatory accounting regarding the associated risks and the medicalisation of very severe obesity. Participants experienced a lack of formal healthcare support in the postnatal period. Future approaches to policy and practice should consider ways in which to engage women and partners during pregnancy, exploring ways which in which stigma can be acknowledged and neutralised, in order to provide support and advice during and after pregnancy and birth, and into parenthood.

Neurodevelopmental conditions like Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) impact a significant number of children and adults worldwide. Currently, the means of diagnosing of such conditions is carried out by experts, who employ standard questionnaires and look for certain behavioural markers through manual observation. Such methods are not only subjective, difficult to repeat, and costly but also extremely time consuming. However, with the recent surge of research into automatic facial behaviour analysis and it's varied applications, it could prove to be a potential way of tackling these diagnostic difficulties. Automatic facial expression recognition is one of the core components of this field but it has always been challenging to do it accurately in an unconstrained environment. This thesis presents a dynamic deep learning framework for robust automatic facial expression recognition. It also proposes an approach to apply this method for facial behaviour analysis which can help in the diagnosis of conditions like ADHD and ASD. The proposed facial expression algorithm uses a deep Convolutional Neural Networks (CNN) to learn models of facial Action Units (AU). It attempts to model three main distinguishing features of AUs: shape, appearance and short term dynamics, jointly in a CNN. The appearance is modelled through local image regions relevant to each AU, shape is encoded using binary masks computed from automatically detected facial landmarks and dynamics is encoded by using a short sequence of image as input to CNN. In addition, the method also employs Bi-directional Long Short Memory (BLSTM) recurrent neural networks for modelling long term dynamics. The proposed approach is evaluated on a number of databases showing state-of-the-art performance for both AU detection and intensity estimation tasks. The AU intensities estimated using this approach along with other 3D face tracking data, are used for encoding facial behaviour. The encoded facial behaviour is applied for learning models which can help in detection of ADHD and ASD. This approach was evaluated on the KOMAA database which was specially collected for this purpose. Experimental results show that facial behaviour encoded in this way provide a high discriminative power for classification of people with these conditions. It is shown that the proposed system is a potentially useful, objective and time saving contribution to the clinical diagnosis of ADHD and ASD.

O objetivo deste estudo foi avaliar a evolução do estado nutricional, a ingestão alimentar por via oral (VO) e a utilização de terapias nutricionais complementares durante a internação de crianças e adolescentes submetidos ao transplante de células-tronco hematopoéticas (TCTH) alogênico em um hospital terciário. Estudo retrospectivo, com revisão de prontuários de pacientes submetidos ao TCTH, com idade entre 0 e 19 anos incompletos, entre janeiro de 2009 e dezembro de 2014. Foram coletados dados referentes a dados antropométricos, ingestão alimentar por VO, terapias nutricionais utilizadas (nutrição enteral (NE) e/ou parenteral (NP)); e sinais e sintomas clínicos em seis momentos: Internação, D0 (dia da infusão de células), D+7, D+14, D+21 e D+ 28. Foram avaliados 63 pacientes, 56% do sexo masculino, com uma mediana de idade de 10 anos. No momento da internação 100% dos pacientes tiveram suas necessidades energéticas atingidas pela VO, diminuindo a partir do D0 (cerca de 30%), com maior prevalência de utilização de NP e NE a partir do D+7. Inapetência, mucosite e náusea foram os sinais e sintomas mais frequentes. A partir do D+21 foi possível observar um aumento do aporte calórico por VO. Os pacientes apresentaram diminuição da ingestão alimentar ao longo da internação, porém, neste hospital, já se está conseguindo atingir um aporte calórico mais próximo do ideal, com auxílio de terapias nutricionais complementares. / The aim of this study was to describe the nutritional aspects relevant to the maintenance of a nutritional status during hospitalization of children and adolescents undergoing allogeneic hematopoietic stem cell transplantation (HSCT) at a tertiary hospital. A retrospective study with a review of medical records of patients undergoing HSCT, aged between 0 and 19 years of age (incomplete) between January 2009 and December 2014. Data were collected regarding food intake, nutritional therapies used, and clinical signs and symptoms in six times: Hospitalization, D0 (day of cell infusion), D+7, D+14, D+21 and D+28. Sixty-three patients were evaluated, being 56% males, with a median age of 10 years. At the time of hospitalization, 100% of patients had their energy needs met by mouth, decreasing from D0 (about 30%), with more prevalent use of PN (parenteral nutrition) and EN (enteral nutrition) from D+7. Loss of appetite, mucositis and nausea were the most frequent signs and symptoms. From D+21 it was possible to observe an increase in caloric intake by mouth. Patients showed decreased food intake throughout hospitalization, but in this hospital it has been already possible to get calorie intake closer to the ideal one with the help of complementary nutritional therapies.

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2016-07-26T14:42:42Z No. of bitstreams: 1 liliangoraieb_tese.pdf: 804095 bytes, checksum: 06542107c917aa2ae6717d3edf30330c (MD5) / Made available in DSpace on 2016-07-26T14:42:42Z (GMT). No. of bitstreams: 1 liliangoraieb_tese.pdf: 804095 bytes, checksum: 06542107c917aa2ae6717d3edf30330c (MD5) Previous issue date: 2013-11-28 / Introduction: Due to the large number of congenital heart disease with several surgical treatment variables involved, it has not yet been established objective protocols for mechanical ventilation weaning in the postoperative period of cardiac surgery. Objectives: To determine the duration of mechanical ventilation (MV) and the success or failure of extubation using an adapted protocol to spontaneous respiratory test in children undergoing cardiac surgery. Patients and methods: A prospective study with 43 operated patients in the Intensive Care Unit under mechanical ventilation for 24 hours or more. They were randomized into two groups: A - Routine (19) and B - Protocol (24). In A, extubation followed routine multidisciplinary team management of intensive care unit. In B, the patients were considered suitable to spontaneous respiratory test after an evaluation. The extubation would occur with the success of the test (120 minutes). The groups were also evaluated according to the severity of the estimated risk. Fisher Bi-Caudal and unpaired student´s t tests were applied. The study was approved by the Research Ethics Committee. Results: There was no statistically significant difference between groups regarding the duration of mechanical ventilatioon (P= 0.81), as well as the success or failure of extubation (P=0.40). Regarding severity, no statistically significant differences were found when evaluated for MV time (P = 0.45 - RACHS 1 and 2) (P=0.59 - RACHS 3 and 4), as well as to success or failure of extubation (P=0.67 - RACHS 1 and 2) ( P= 0.49 - RACHS 3 and 4). Conclusions: The use of the SRT protocol for two hours has not shown to be superior to MV time or to the success or failure of extubation in patients undergoing surgical repair of congenital heart defects. / Introdução: Devido ao grande número de cardiopatias congênitas com diversas variáveis envolvidas no tratamento cirúrgico, ainda não estão estabelecidos protocolos objetivos de desmame da ventilação mecânica no pós-operatório de cirurgia cardíaca pediátrica. Objetivos: Verificar se o uso do protocolo de desmame com teste de respiração espontânea de 120 minutos tem impacto no tempo de ventilação mecânica e no sucesso ou insucesso da extubação para crianças que não foram extubadas nas primeiras 24 horas após a intervenção cirúrgica. Casuística e método: Estudo prospectivo realizado em unidade de terapia intensiva cardiopediátrica com 45 pacientes operados em ventilação mecânica por 24 horas ou mais. Foram randomizados em dois grupos: A - rotina (21) e B - protocolo (24). No A, a extubação seguiu conduta de acordo com a equipe multidisciplinar da unidade de terapia intensiva. No B, após avaliação os pacientes eram considerados aptos ao teste de respiração espontânea. A extubação ocorria com o sucesso do teste (120 minutos). Os grupos também foram avaliados de acordo com a gravidade pelo risco estimado. Aplicaram-se os testes de Fisher Bi-Caudal e t não pareado. O estudo foi aprovado pelo Comitê de Ética em Pesquisa. Resultados: Não houve diferença estatística significativa entre os grupos quanto ao tempo de ventilação mecânica (P = 0,81), assim como quanto ao sucesso ou insucesso da extubação (P = 0,40). Com relação à gravidade, também não foram encontradas diferenças estatísticas significativas quando avaliados quanto ao tempo de ventilação mecânica (P=0,45 – RACHS 1 e 2) e (P=0,59 – RACHS 3 e 4), assim como quanto ao sucesso ou insucesso da extubação (P = 0,67 – RACHS 1 e 2) e (P = 0,49 – RACHS 3 e 4). Conclusões: A utilização desse protocolo com teste de respiração espontânea de duas horas não demonstrou ser superior quanto ao tempo de ventilação mecânica e ao sucesso ou insucesso na extubação de pacientes submetidos à correção cirúrgica de defeitos cardíacos congênitos.

Submitted by Suzana Dias (suzana.dias@famerp.br) on 2018-10-18T21:36:00Z No. of bitstreams: 1 AlexandreMurakami_dissert.pdf: 1293818 bytes, checksum: d98c26e3e45ebf6e17599765f2d44e2d (MD5) / Made available in DSpace on 2018-10-18T21:36:00Z (GMT). No. of bitstreams: 1 AlexandreMurakami_dissert.pdf: 1293818 bytes, checksum: d98c26e3e45ebf6e17599765f2d44e2d (MD5) Previous issue date: 2018-07-27 / Developing countries have been dealing with several difficulties concerning congenital heart diseases. Among them is lack of control of results through some specific database. The participation in the International Quality Improvement Collaborative Database for Congenital Heart Disease (IQIC) - Improving care in low- and middle-income countries provides an opportunity to improve quality of care targeting morbidity and mortality reduction, facilitated by the establishment of parameters and objective data to evaluate treatment offered. Objective: To analyze factors in the International Quality Improvement Collaborative Database for Congenital Heart Disease (IQIC) database of a single center of cardiology and pediatric cardiovascular surgery that influenced the quality of care to patients with congenital heart disease. Casuistic and Methods: Data collection from January 2011 to December 2017 independently and with external audit by IQIC database partnership. Data included preoperative information such as demographic data, nutritional status, associated chromosomal abnormalities, Risk Adjustment for Congenital Heart Surgery (RACHS-1) score, as well as postoperative information such as infections, complications in the first 30 days or until hospital discharge and / or patient death. Results: In the preoperative period, there was a clear trend of increasing newborn patient cases, in detriment of those 1 to 18 years of age. There was a reduction in cases of malnutrition from 70% in 2013 to 55% in 2017. The postoperative period reveled significant variation between groups’ surgical procedures in RACHS-1 risk category (P= 0.003), prevalence of risk categories 2 and 3, as well as an increase in cases of risk categories 4,5 and 6, mainly in the last two years. Infection and mortality showed favorable results for reduction, with statistical significance for surgical site infection (P= 0.03), bacterial sepsis and other infections (both P <0.001). The 30-day postoperative follow-up showed a satisfactory evolution for discrete reduction in mortality, but not statistically significant difference in both in-hospital death (P=0.16) and 30 days (P=0.14). Conclusion: The analysis of the seven years of the IQIC database showed significant decrease in infection, increase in complexity of cases and reduction of mortality of patients with congenital heart disease in our environment. / Países em desenvolvimento enfrentam diversas dificuldades em relação às cardiopatias congênitas, dentre elas a falta de controle de resultados por meio de banco de dados específico. A participação no banco de dados International Quality Improvement Collaborative for Congenital Heart Disease (IQIC) - Improving care in low- and middle-income countries forneceu oportunidade de melhoria da qualidade na assistência para a redução de morbidade e mortalidade infantil, facilitada pelo estabelecimento de parâmetros e dados objetivos para avaliação de tratamentos oferecidos. Objetivo: Analisar os fatores do banco de dados International Quality Improvement Collaborative for Congenital Heart Disease (IQIC) – Improving care in low and middle income countries de um centro único de cardiologia e cirurgia cardiovascular pediátrica que influenciaram a qualidade de atendimento aos pacientes com cardiopatias congênitas. Casuística e Método: Coleta de dados no período de Janeiro de 2011 a Dezembro de 2017 de forma independente e com auditoria externa em parceria com banco de dados IQIC. Os dados incluíram informações pré-operatórias, tais como: dados demográficos, estado nutricional, síndromes associadas e categoria de risco cirúrgico (Risk Adjustment for Congenital Heart Surgery - RACHS-1), assim como, informações pós-operatórias como infecções, complicações nos primeiros 30 dias até a alta hospitalar e ou óbito do paciente. Resultados: No período pré-operatório, observou-se nítida tendência de aumento de casos de pacientes recém-nascidos em detrimento aos de 1 a 18 anos. Encontrou-se redução de casos com desnutrição de 70% em 2013 para 55% em 2017. No período pós-operatório os procedimentos cirúrgicos classificados na categoria de risco RACHS-1 revelaram variação significante entre os grupos (P=0,003), prevalecendo as categorias de grau 2 e 3, assim como, aumento de casos de categorias de risco 4,5 e 6, principalmente nos dois últimos anos do estudo. A infecção e mortalidade demonstraram resultados favoráveis para a redução, com significância estatística para infecção de sítio cirúrgico (P=0,03), sepse bacteriana e outras infecções (P<0,001). O acompanhamento de 30 dias de pós-operatório mostrou evolução satisfatória para discreta redução dos óbitos, porém sem diferença estatística tanto para morte intra-hospitalar (P=0,16) como em 30 dias (P=0,14). Conclusão: A análise dos sete anos do banco de dados IQIC permitiu demonstrar a diminuição significante de infecção, aumento da complexidade das doenças e redução da mortalidade dos pacientes com cardiopatias congênitas em nosso meio.

Background and aims: Leukaemia is a cancer of the blood and is the most common type of childhood cancer with almost 500 new cases every year in the UK. There is a vast amount of research exploring the experiences of parents of children with cancer, however, there is less research focussed on parents whose children are in the maintenance phase of Acute Lymphoblastic Leukaemia (ALL) treatment. This treatment phase usually occurs in the first or second year following diagnosis but can start much earlier. The maintenance phase still involves active treatment but with less visits to and stays in hospital. At this stage, parents have been through the most intense segment of the treatment regimen and may have encountered various Khalighyprotocol may therefore have valuable advice to provide to other parents regarding coping and useful supports. This study aimed to explore the coping style and patterns of accessing support in mothers and fathers who have a child diagnosed with ALL and who are in the maintenance phase of treatment. The aim was also to explore whether there were differences between mothers and fathers with regards to coping and support. Methods: Three mothers and two fathers were interviewed separately using a semi structured interview. These interviews were then transcribed and analysed using interpretative phenomenological analysis (IPA). Results: Four main themes were identified through interviews with parents: the parental role; internal coping strategies; external coping strategies; and looking to the future. Conclusions: Parents were found to use a variety of coping strategies and accessed various sources of support to help them to deal with their child’s ALL diagnosis. These coping strategies could be shared with parents who are new to the haematology service. There were however, significant difficulties with recruitment which means it was not possible to compare mothers and fathers in terms of coping style and types of support accessed. This highlights that the recruitment strategy needs revising if further research is to be conducted in this area.

Os profissionais que acompanham a saúde e desenvolvimento criança de forma sistemática nos primeiros aos de vida, são fundamentais no processo de aquisição e desenvolvimento da linguagem. Este estudo teve por objetivo desenvolver e analisar um ambiente virtual de aprendizagem, na área de Fonoaudiologia, aquisição e desenvolvimento da linguagem infantil para orientação dos médicos pediatras, com a utilização da Teleducação Interativa. A metodologia seguiu as seguintes fases de desenvolvimento: Análise e Planejamento, Modelagem, Implementação e Avaliação. Foi realizada uma ampla revisão de literatura sobre as etapas de desenvolvimento da linguagem, de forma cronológica, desde o nascimento até os 7 anos de idade, indicando as principais características e os marcos do desenvolvimento em cada fase, para confecção do material a ser implementado no ambiente virtual de aprendizagem em formato de blog. O material desenvolvido foi disponibilizado no endereço eletrônico http://fonoaudiologiaparapediatras.wordpress.com./. Este material foi avaliado do ponto de vista da qualidade técnica e do conteúdo por 63 fonoaudiólogos por meio de dois questionários, sendo o primeiro denominado de Emory adaptado e o segundo correspondendo à avaliação específica do conteúdo do blog elaborado pela pesquisadora. Os resultados demonstraram que o blog foi avaliado como Excelente quanto aos aspectos: conteúdo, precisão, autoria, atualizações, público, navegação, links externos e estrutura, bem como na avaliação específica do conteúdo. Outro ponto favorável foi o alcance do material, no período de setembro a dezembro de 2012 o blog Fonoaudiologia e Pediatria recebeu 5.046 visitas de diversos países, além do Brasil, demonstrando o uso frequente da internet para obtenção de informações na área da saúde. Portanto, um ambiente virtual de aprendizagem contendo informações sobre a aquisição e desenvolvimento da linguagem foi desenvolvido, a fim de orientar médicos pediatras englobando desde fases típicas a alterações, prevenção, fases do desenvolvimento e possíveis encaminhamentos. / Professinals who accompanying the child health and development systematically in the early years of his life, are fundamental in process of language acquisition and development. The present study aimed to develop and analyze an electronic media material in the field of speech pathology focusing on childish development and acquisition language to guide pediatric doctors, using the Interactive Tele-education. The methodology follows the following stages of development: Planning and Analysis, Modelling, Implementation and Evaluation. Was performed wide a literature review about the stages of language development, chronologically, from birth until the age of 7, pointing out the main characteristics and developmental marks at each stage, for preparing the material to be implemented in the virtual learning environment in blog format. The material made is available on the electronic address http://fonoaudiologiaparapediatras.wordpress.com/. This material was evaluated in terms of technical quality and content by 63 speech therapists through two questionnaires, the first one is an adaptation of Emory and the second one corresponding to the specific evaluation of the blog content, prepared by the researcher. The results demonstrated that the blog has been rated as \"Excellent\" on the aspects: content, accuracy, authorship, updates, public, navigation, external links and structure, as well as in the specific content evaluation. Another favorable point was the scope of the material, from September to December 2012 the blog \"Speech Pathology and Pediatrics\" received 5.046 visits from several countries, besides the Brazil, demonstrating the frequent use of internet to obtain information on health. Thereby, a virtual learning environment, in blog format, containing information on the acquisition and development of language was developed to guide pediatric doctors from typical phases subject to changes, prevention, stages of development and possible referrals.

O objetivo deste estudo é analisar as informações fornecidas por profissionais envolvidos durante a morte e como compreenderam as suas próprias ações no momento de comunicação da morte. É assim, visando esse objetivo acima citado, que este trabalho pretende responder à questão de quais foram as preocupações dos profissionais médicos, numa unidade de terapia intensiva, ao depararem-se com a comunicação de óbito aos familiares de pacientes internados. As informações foram obtidas através de pesquisa descritiva, de abordagem qualitativa, após entrevistas semiestruturadas conduzidas aos profissionais que forneceram a comunicação, durante o período de três meses no ano de 2013. A análise das entrevistas e de seus respectivos conteúdos proporcionou a divisão em duas categorias – Compreensão da Notícia e Limitação da Medicina/Proximidade da Morte. Ambas as categorias proporcionaram intensa análise e comparação com referências bibliográficas sobre como esses momentos eram encarados em diversos aspectos: médicos, psíquicos, filosóficos e até mesmo religiosos. Podemos, sob o aspecto subjetivo que é inerente a esta pesquisa, perceber que nos momentos finais da vida os pediatras selecionados neste trabalho preocuparam-se, principalmente, com o caminho no qual a comunicação encontrava o seu receptor e quais entendimentos os familiares obtinham através da informação que era fornecida. Também nota-se a preocupação dos médicos em estabelecer o limite terapêutico, e quando a proximidade da morte era maior que a possibilidade de interferência de potenciais intervenções terapêuticas. Os entrevistados demonstraram a necessidade de estabelecer o momento em que se deveria evitar a agregação de terapias fúteis e obstinadas, mantendo a família, em sua visão, com a maior informação possível desses limites. / We aimed with this study, to analyse how information was given by pediatrician to the families who underwent with a children who died in a Pediatric Intensive Care at Porto Alegre, Brazil, and how this pediatricians understood they’re own actions at the moment of the breaking bad news. Information was given through a descriptive research, with qualitative analysis, after semi-structured interviews conducted to the physicians who were breaking the bad news in the period of three months of 2013. Analysis of the interviews and respective contents allowed division in two main themes – Comprehension of the news and The edge between Medicine and proximity of death. Both categories allowed intense analysis and links with medical literature about how this moments are faced, through several aspects: medical, psychological, philosophical an even religious. We can, through this kind of analysis, sense that at the final moments of life, pediatricians selected were worried, mainly, with the potential distance between breaking bad news and comprehension of the parents. Also, in this study, we can notice, several times, during the interviews, concerning of the medical team to state when therapeutical limits were reached. Pediatricians at this study showed needs to maintain clear communication when these limits were set, and through a continuous process to inform the family. Interviewers showed importance in keep families connected with the ideas when new treatments were futile.