Cristina malzoni ferreira mangia

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PhD/Pediatrics Department/UNIFESP
Universidade Federal de São Paulo


Graduated in Medicine from the State University of Campinas - UNICAMP (1985), medical residency from the Julio de Mesquita Filho University - UNESP (1987), specialization in Pediatric Intensive Care from the Federal University of São Paulo - UNIFESP (1989); former trainee physician at the Pediatric ICU at the University of São Paulo - USP (1988), Master's degree from UNIFESP (2000) and Doctorate from UNIFESP (2006). Researcher affiliated with Professor Joseph Carcillo of Children's Hospital of Pittsburgh - UNIVERSITY of PITTSBURGH (2006) And collaborator in several research projects. She is co-founder and member of 1o. executive committee of the INTERNATIONAL PEDIATRIC SEPSIS INITIATIVE which, due to its relevance, was endorsed by the WORLD FEDERATION OF PEDIATRIC INTENSIVE CARE AND CRITICAL CARE SOCIETIES. Former researcher affiliated with Professor Niranjan Kissoon at UNIVERSITY BRITISH COLUMBIA (2006). She advises several national and international journals in the peer-review


1980 - 1985 Graduation in Medicina .
Universidade Estadual de Campinas, UNICAMP, Brasil.
1989 - 1990 Specialization in Terapia Intensiva Pediátrica . (Carga Horária: 2880h).Federal de São Paulo, UNIFESP, Brasil
1986 - 1987 Specialization - Medical Residence .
Universidade Estadual Paulista Júlio de Mesquita Filho, UNESP, Brasil. Medical Residence in: Pediatria
MBA in Health Management and Economics (CPES) .
Federal University of São Paulo, UNIFESP, Brazil.
2000 Master's in Pediatrics and Sciences Applied to Pediatrics Federal University of São Paulo, UNIFESP, Brazil.
2006 phD Doctor in Science Federal University of São Paulo, UNIFESP, Brazil.


Pediatric, emergencies, intensive care, sepsis, septic shock, prognostic, bioimpedance, multiple organ dysfunction



Description: This research will be carried out with the objective of implementing a hybrid program of continuing education and research with thematic area in pediatric septic shock whose objective is to improve the quality, care indicators and care management of patients admitted to the pediatric units of the University Hospital linked to UNIFESP, Hospital São Paulo. Initial management analysis focusing on the main barriers that interfere with the quality of care and proposing solutions to resolve them. Subsequently, the objective is: 1) to develop a module of continuing education based on good educational practices 2) to evaluate the impact of the teaching program, on adherence to the sepsis and septic shock management program, on the outcome and on the indicators of care quality management ..

Applications Invited
Pediatric mortality by sepsos

Scopus Publications

Scopus Publications

  • Bacterial sepsis in Brazilian children: A Trend Analysis from 1992 to 2006
    Cristina Malzoni Ferreira Mangia, Niranjan Kissoon, Otavio Augusto Branchini, Maria Cristina Andrade, Benjamin Israel Kopelman, and Joe Carcillo

    PLoS ONE, eISSN: 19326203, Published: 2011 Public Library of Science (PLoS)
    BACKGROUND The objective of this study was to determine the epidemiology of hospitalized pediatric sepsis in Brazil (1992-2006) and to compare mortality caused by sepsis to that caused by other major childhood diseases. METHODS AND FINDINGS We performed a retrospective descriptive study of hospital admissions using a government database of all hospital affiliated with the Brazilian health system. We studied all hospitalizations in children from 28 days through 19 years with diagnosis of bacterial sepsis defined by the criteria of the International Classification of Diseases (ICD), (Appendix S1). Based on the data studied from 1992 through 2006, the pediatric hospital mortality rate was 1.23% and there were 556,073 pediatric admissions with bacterial sepsis with a mean mortality rate of 19.9%. There was a case reduction of 67% over 1992-2006 (p<0.001); however, the mortality rate remained unchanged (from 1992-1996, 20.5%; and from 2002-2006, 19.7%). Sepsis-hospital mortality rate was substantially higher than pneumonia (0.5%), HIV (3.3%), diarrhea (0.3%), undernutrition (2.3%), malaria (0.2%) and measles (0.7%). The human development index (HDI) and mortality rates (MR) by region were: North region 0.76 and 21.7%; Northeast region 0.72 and 27.1%; Central-West 0.81 and 23.5%; South region 0.83 and 12.2% and Southeast region 0.82 and 14.8%, respectively. CONCLUSIONS We concluded that sepsis remains an important health problem in children in Brazil. The institution of universal primary care programs has been associated with substantially reduced sepsis incidence and therefore deaths; however, hospital mortality rates in children with sepsis remain unchanged. Implementation of additional health initiatives to reduce sepsis mortality in hospitalized patients could have great impact on childhood mortality rates in Brazil.

  • Sepsis and septic shock: A global overview
    Cristina Mangia, Joseph Carcillo, and Niranjan Kissoon

    Journal of Pediatric Infectious Diseases, ISSN: 13057707, Pages: 71-76, Published: 2009 IOS Press
    Severe sepsis and septic shock are life-threatening diseases in both developed and developing countries and is an important risk factor for morbidity and mortality in all age groups. In developing countries, there is a direct relationship between the incidence of infections and mortality under five years of age. Child mortality in these scenarios is complex and involves issues such as lack of preventative care, malnutrition, poverty, and lack of resources, that together contribute to the increased incidence and poor outcomes in sepsis. The concept of integrated management of childhood illness that involves the community, family and health systems is an important way that has been proposed for reduce children mortality and morbidity in developing nations and should be applied in sepsis initiatives. Sepsis and septic shock are observed time-sensitive, early diagnosis and prompt treatment have been related to good outcome. Actions such as prevention sound public health policies, educational programs for health care providers, family and community may help to reduce the global burden of this disease in children.

  • Anomalous left coronary artery from pulmonary artery: Autogenous arterial tube for aortic implantation
    Journal of Cardiovascular Surgery, ISSN: 00219509, Pages: 577-579, Published: 2004

  • Cerebral sinovenous thrombosis in a nephrotic child
    Marcelo Masruha Rodrigues, Lilian Rocha Zardini, Maria Cristina de Andrade, Cristina Malzoni Ferreira Mangia, João Tomas de Abreu Carvalhaes, and Luiz Celso Pereira Vilanova

    Arquivos de Neuro-Psiquiatria, ISSN: 0004282X, Pages: 1026-1029, Published: December 2003 FapUNIFESP (SciELO)
    Nephrotic syndrome in infancy and childhood is known to be associated with a hypercoagulable state and thromboembolic complications, but cerebral sinovenous thrombosis (CST) is a very rare and serious one, with only a few isolated reports in the literature. A case is presented of a 9-year-old boy with nephrotic syndrome that acutely developed signs and symptoms of intracranial hypertension syndrome. CST was diagnosed on cranial CT and MRI and he gradually recovered after treatment with anticoagulants. The diagnosis of CST should be considered in any patient with nephrotic syndrome who develops neurologic symptoms. The discussion of this case, coupled with a review of the literature, emphasizes that early diagnosis is essential for institution of anticoagulation therapy and a successful outcome. This report also illustrates the difficulties that may be encountered in managing such a patient.

  • Conventional and conventional plus modified ultrafiltration during cardiac surgery in high-risk congenital heart disease
    Journal of Cardiovascular Surgery, ISSN: 00219509, Pages: 465-473, Published: 2001

  • Use of total body impedance index in cardiac surgery with cardiopulmonary bypass in children
    Werther B. Carvalho, Cristina M. F. Mangia, Nilton F. Oliveira, Joao A. Mattar, Miguel A. Maluf, and Douglas Nobrega

    Critical Care Medicine, ISSN: 00903493, Issue: 1 SUPPL., Published: 1999 Ovid Technologies (Wolters Kluwer Health)

  • Management of acute seizure episodes and status epilepticus in children
    Erasmo B. Casella and Cristina M. F. Mângia

    Jornal de Pediatria, ISSN: 00217557, Issue: SUPPL. 2, Published: 1999 Jornal de Pediatria
    OBJECTIVE: The authors make an up-to-date review about diagnosis and treatment of the acute seizures and status epilepticus.METHODS: Bibliographic review of Medline database including articles published in the last ten years.RESULTS: Acute seizures and status epilepticus affect children of all the age groups. Acute seizures can either represent the first manifestation of an epileptic condition or be an acute symptomatic event. Status epilepticus represents a serious cerebral insult determined by various causes. The emergency, neurology and pediatric intensive care units should elaborate clinical policy for the establishment of precise diagnostic criteria and therapeutic approach. A good clinical approach should include immediate life support, monitoring and rational drug administration to end up the seizure and reduce morbidity and mortality risks.CONCLUSION: The better understanding of the pathophysiology as well as the elaboration of a rational clinical policy improved the outcome in these medical emergencies.

  • Withdrawal syndrome associated with cessation of fentanyl and midazolam in pediatrics
    J.N. Bicudo, N. de Souza, C.M.F. Mângia, and W.B. de Carvalho

    Revista da Associação Médica Brasileira (1992), ISSN: 01044230, Pages: 15-18, Published: 1999 Jan-Mar Elsevier BV
    PURPOSE: To determine the incidence of abstinence syndrome in children interned in the Pediatric Intensive Care Unit (PICU) in fentanyl use and midazolam METHODS: Evaluation of 36 children interned in PICU of the Hospital Sao Paulo - Federal University of Sao Paulo, in the period from March to September 1997, with age varying from 5 days to 22 months (22 masc: 14 fem) who used fentanyl use and midazolam for more than 24 hours. Used the Escore Neonatal of Abstinence adapted by Finnegan determines the occurrence of abstinence syndrome in was used to children 2 years old or less. Sustain larger or equal for 8 is considered as abstinence syndrome. Correlated the abstinence syndrome with the accumulated total dose, infusion velocity, daily dose and time of use of the fentanyl and midazolam. RESULTS: Certain abstinence syndrome in 18 (50%) of the 36 children. Applied Mann Whitney's statistical test to compare the groups with and without abstinence syndrome. Dose accumulated of fentanyl total (5732.7 ± 5114.91 vs 624.2 ± 591.2 mcg, p < 0.005), dose daily of fentanyl (98.54 ± 6.12 vs 36.23 ± 23.42 mcg/Kg/dia, p < 0.005), velocity of infusion of the fentayl (4.09 ± 2.75 vs 1.5 ± 0.95 mcg/Kg/hora, p < 0.005), time of use of the fentanyl (10.2 ± 5.1 vs 3.16 ± 1.09 days, p < 0.005), dose accumulated of midazolam total (118.8 ± 86.97 vs 20.03 ± 14.79 mg, p < 0.005), dose daily of midazolam (2.32 ± 0.86 vs 1.21 ± 0.68 mg/Kg/dia, p < 0.005), velocity of midazolam infusion (0.13 ± 0.16 vs 0.05 ± 0.02 mg/Kg/hora, p < 0.005) and time of use of the midazolam (9.20 ± 4.67 vs 2.55 ± 1.54 days, p < 0.005) they were considered significant. CONCLUSION: The abstinence syndrome presents an elevated incidence in children interned in PICU owing to the interruption of the fentanyl infusion and midazolam and in these patients it was related with the dose and the time of use.

  • Effects on the pulmonary function after single dose of exogenous pulmonary surfactant in children with acute respiratory distress syndrome
    W.B. de Carvalho and C.M.F. Mângia

    Revista da Associação Médica Brasileira (1992), ISSN: 01044230, Pages: 145-150, Published: 1997 Apr-Jun Elsevier BV
    The Acute Respiratory Distress Syndrome (ARDS) is a pulmonary lesion of multifactorial cause in which the surfactant system is altered owing to inactivation and impairment of composition and metabolism. The use of exogenous pulmonary surfactant is a therapeutic option with the objective to maintain alveolar stability thus improving the pulmonary compliance (increasing the residual functional capacity), oxygenation and ventilatory mechanics. A study carried out on two pediatric patients with ARDS submitted to mechanic pulmonary ventilation, applying a single dose of exogenous pulmonary surfactant is described. The patients were evaluated using arterial and venous gasometry before and after the use of surfactant, observing increment in oxygenation, reduction of shunt fraction, improvement in ventilation immediately after exogenous pulmonary surfactant instillation and return to the previous situation after 240 minutes in case 1 and 120 minutes in case 2. More prospective clinical and randomized studies are needed to effectively evaluate this therapeutic modality.