<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1688-1249</journal-id>
<journal-title><![CDATA[Archivos de Pediatría del Uruguay]]></journal-title>
<abbrev-journal-title><![CDATA[Arch. Pediatr. Urug.]]></abbrev-journal-title>
<issn>1688-1249</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Uruguaya de Pediatría]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1688-12492022000101603</article-id>
<article-id pub-id-type="doi">10.31134/ap.93.1.18</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Planificación avanzada del cuidado y adecuación del esfuerzo terapéutico en pediatría. Fundamento y procedimiento]]></article-title>
<article-title xml:lang="en"><![CDATA[Advanced care planning and adequacy of therapeutic effort in Pediatrics. Rationale and procedures]]></article-title>
<article-title xml:lang="pt"><![CDATA[Planejamento avançado do cuidado e adequação do esforço terapêutico na pediatria. Base e procedimento]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bernadá]]></surname>
<given-names><![CDATA[Mercedes]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Notejane]]></surname>
<given-names><![CDATA[Martín]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,UDELAR Facultad de Medicina Clínica Pediátrica]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Uruguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,UDELAR Facultad de Medicina Clínica Pediátrica]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Uruguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2022</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2022</year>
</pub-date>
<volume>93</volume>
<numero>1</numero>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_arttext&amp;pid=S1688-12492022000101603&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_abstract&amp;pid=S1688-12492022000101603&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.edu.uy/scielo.php?script=sci_pdf&amp;pid=S1688-12492022000101603&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen: Las mejoras en la calidad de vida de la población y los avances de la medicina han contribuido al aumento de la sobrevida de niños y adolescentes, así como también un aumento progresivo de niños con enfermedades o condiciones de salud crónicas, complejas, dependientes de dispositivos médicos y/o tecnología, que conviven con la posibilidad de complicaciones que amenazan sus vidas. Esta situación implica múltiples desafíos en los procesos de toma de decisiones respecto a la pertinencia y proporcionalidad de medidas diagnósticas, terapéuticas y de monitorización, considerando el beneficio real y/o la carga de sufrimiento, que las mismas pueden determinar en la calidad de vida del niño y su familia. En los últimos años, en el marco de la atención sanitaria, se han incorporado los conceptos y procedimientos de planificación avanzada del cuidado (PAC) y limitación o adecuación del esfuerzo terapéutico (AET) que se presentan. El objetivo de este documento es describir las definiciones básicas de conceptos necesarios para comprender e implementar procesos de PAC y AET, el marco bioético y legal para dichos procesos, el procedimiento para la implementación de la definición de directivas de adecuación del esfuerzo terapéutico (DAET), elaborado por la Unidad de Cuidados Paliativos Pediátricos del Centro Hospitalario Pereira Rossell.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Summary: Improvements in the populations&#8217;s quality of life and medical progress have contributed to the increase of survival rates of children and adolescents, as well as to a progressive rise in children with chronic, complex diseases or health conditions, dependent on medical devices and / or technology, who live with the possibility of life-threatening complications. This situation brings multiple challenges in the decision-making processes regarding the relevance and proportionality of diagnostic, therapeutic and monitoring measures, considering the real benefit and / or the burden that they can cause in the quality of life of the child and his family. In recent years, within the framework of health care, the concepts and procedures of advanced care planning and limitation or adequacy of therapeutic effort (ATE) have been incorporated. The aim of this paper is to describe the basic definitions needed to understand and implement ATE processes, the bioethical and legal framework for such processes, the procedure for the implementation of the definition of Directives for the Adequacy of Therapeutic Effort (DATE), prepared by the Pediatric Palliative Care Unit of the Pereira Rossell Hospital Center.]]></p></abstract>
<abstract abstract-type="short" xml:lang="pt"><p><![CDATA[Resumo: Melhoras na qualidade de vida da população e avanços na medicina têm contribuído para o aumento da sobrevida de crianças e adolescentes, bem como um aumento progressivo de crianças com doenças crônicas, complexas ou condições de saúde dependentes de dispositivos médicos e/ou tecnologia, que convivem com a possibilidade de complicações que ameaçam suas vidas. Essa situação traz consigo múltiplos desafios nos processos decisórios quanto à relevância e proporcionalidade das medidas diagnósticas, terapêuticas e de monitoramento, considerando o real benefício e/ou a carga de sofrimento, que podem determinar na qualidade de vida da criança e de sua família. Nos últimos anos, no âmbito da atenção à saúde, foram incorporados os conceitos e procedimentos de: planejamento avanc&#807;ado da atenc&#807;a&#771;o e limitac&#807;a&#771;o o adequac&#807;a&#771;o do esforc&#807;o terape&#770;utico (AET). O objetivo deste documento é descrever: as definições básicas de conceitos necessários para à compreensão e implementação dos processos da PAC e AET, do marco bioético e legal para tais processos, do procedimento para a implementação da definição de diretrizes para a adequação do esforço terapêutico (DAET) elaborado pela Unidade de Cuidados Paliativos Pediátricos do Centro Hospitalar Pereira Rossell.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Cuidados paliativos]]></kwd>
<kwd lng="es"><![CDATA[Planificación anticipada de atención]]></kwd>
<kwd lng="es"><![CDATA[Toma de decisiones]]></kwd>
<kwd lng="en"><![CDATA[Palliative care]]></kwd>
<kwd lng="en"><![CDATA[Advance care planning]]></kwd>
<kwd lng="en"><![CDATA[Decision making]]></kwd>
<kwd lng="pt"><![CDATA[Cuidados paliativos]]></kwd>
<kwd lng="pt"><![CDATA[Planejamento antecipado de cuidados]]></kwd>
<kwd lng="pt"><![CDATA[Tomada de decisões]]></kwd>
</kwd-group>
</article-meta>
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