Loma Linda University

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Joanne Baerg, MD
Associate Professor, Surgery
School of Medicine
Associate Professor, Pediatrics
School of Medicine
Presentations    General Academic Presentation
  •  April 2011. Grand rounds for Neonatology Fellows. Congenital Diaphragmatic Hernia- Development of a Clinical Care Strategy ( 1/2011 - 4/2011 )
  • Grand Rounds:  Department of Pediatrics, Loma Linda University "Gastroesophageal Reflux Disease in Infants" - February 6, 2009. ( 2/2009 - Present )
  Research Presentations -- International
  • Baerg J, St Peter SD, Gassior A, Vannix R, Tagge E.  A Multicenter Study of Factors Associated with Non-Survival After Nissen Fundoplication in Children. (10 min) Canadian Association of Pediatric Surgeons.  Canada September 2013


    ( 3/2014 )
    Accepted for Publication In European Journal of Pediatric Surgery  Feb 2014
  • Baerg J, Thorpe D,Adam Woelk, Nicole E. Sharp MD²Shannon Longshore MD¹Donna Goff MD, MS¹Shandee Hutson MD¹Shawn D. St. Peter MD.  A Multicenter Study of Factors Associated with Non-Survival in Infants with Omphalocele.  Canadian Association of Pediatric Surgeons.  Canada. September 2013

    ( 3/2014 )
  • J Baerg MD, S. St. Peter MD, D Thorpe PhD, G. Bulton MD, RVannix  NP,  M Knott MD, A Gassier MD,  S Sharp PhD,  E Tagge MD. A Multicenter Study of the Incidence and Factors Associated with Redo Nissen Fundoplication in Children.  5 Min Podium Presentation. American Academy of Pediatrics Surgery Section, New Orleans LA. October 2012. ( 10/2012 - 11/2013 )
    Published in JPS 2013
  • Sept 2011:  5 Min Podium Presentation- Canadian Association of Pediatric Surgeons:  Endoscopic Excision of Two Midline, Sternal Subcutaneous Dermoids  Joanne Baerg B.Sc., MD [1], Jukes Namm MD 2, Jasmine Wong MD 2, Marcos Michelotti MD 2         ( 4/2011 - 9/2011 )
  • A multicenter Study of laparoscopic Adrenalectomies   Podium presentation (5 min)             A project of the IPEG Research Committee             International Pediatric Endosurgery Group             Prague, Czech Republic             May 2011 ( 5/2011 )
  • Baerg, Kanthimathinathan, Moores.  Late Presenting Congenital Diaphragmatic Hernia:  A 21 year Single Center Review Poster and oral presentation (3 min) at the International Meeting of the CDH Study Group Rome,  Italy   February 2011 ( 2/2011 )
    LATE PRESENTING CONGENITAL DIAPHRAGMATIC HERNIA:  A 21-YEAR SINGLE CENTER REVIEW   J Baerg MD, V Kanthimathinathan MD, D Moores MD Loma Linda University Children’s Hospital, Loma Linda, CA   Aim:  To describe the  outcome of children with late presenting congenital diaphragmatic hernia (CDH) and compare the most recent decade (2000-2009) to the previous decade (1989-1999) for changes in the clinical practice.   Methods:  After IRB approval, patients who presented  with CDH between 30 days and 18 years, between January 1989 and December 2009, were reviewed retrospectively.  Outcome data were collected by telephone survey in 2010. Data were compared by Fisher exact test and t-test. P<0.05 was  significant.   Results:  During the study period, 31 children (22/31(71%) males) presented between 45 days and 13 years (median:  9 months). Morgagni hernia was present in 14/31(45%) and Bochdalek in 17/31(55%).  There were 20/31(64%) left-sided, 8/31(26%) right-sided and 3/31(10%) bilateral.  Acute symptoms were present in 24/31(77%), chronic symptoms in 5/31(17%), and 2/31(6%) had an incidental diagnosis of CDH.  There were 10/31(32%) misdiagnosed as pneumonia, one patient having undergone a prior thoracotomy for empyema at another center.  There was 1/31(3%) misdiagnosed as a chest mass, who required extensive intestinal resection after strangulation in a left Bochdalek hernia.  Between 1989-1999, 14/31(45%) open repairs were performed, 2/14(14%) with patch.  Between 2000-2009, 17/31(55%) repairs were performed, 7/17(41%) laparoscopic.  Blood loss (p=0.04), post-op ventilation (p=0.004) and hospital stay (p= 0.04) were significantly higher between 1989-1999.  Operative times were significantly longer (p=0.005) between 2000-2009.  Telephone follow-up was complete for 27/31(87%) and ranged from 1-20 years (median: 7 years).  All survived, none had surgery for recurrence, malrotation or bowel obstruction. The child with bowel strangulation is alive at 18 years with short bowel on TPN.   Conclusion:  Patients with repaired, late presenting CDH survive  without sequellae, unless misdiagnosis occurs.  Clinical practice is improving.   The most recent decade demonstrates significant improvements in length of stay, operative blood loss and use of postoperative ventilation.  The increased operative times reflect the learning curve of laparoscopic repairs.  
  • Baerg, Michelotti, Tamez, Reeves  Laparoscopic Intracorporeal Suturing Among Residents, Can We Predict Success? Poster and Oral Presentation (3min)  International Pediatric Endosurgery Group,  Hawaii, USA   June 2010. ( 6/2010 )
      Aim:  To identify factors associated with residents who attained a predetermined level of competence in laparoscopic intracorporeal suturing. Methods:  IRB approval was obtained.  Data was gathered prospectively between July 1, 2009 and March 1, 2010.  A goal was set that residents would practice intracorporeal suturing in a simulator until they could perform one surgeon’s knot and five more throws in under 5 minutes.  Residents from 5 postgraduate years presented individually for a tutorial with one pediatric surgeon.  Residents first practiced the movements outside the simulator.  When they could produce the movements with a needle driver and forceps, they proceeded to the simulator.  They practiced individually with one pediatric surgeon until they could perform an intracorporeal suture.  Baseline times were recorded.  A survey about previous laparoscopic experience   was given to each resident.  Each was then instructed to continue to return to the simulator to practice until they could perform an intracorporeal suture  within the goal time of 5 minutes.  Besides this predetermined speed, they were instructed to practice until they did not drop the needle and could keep the instrument tips within an 8 by 8 cm area.  Logs to keep track of practice dates and times were administered. Data from surveys, official case logs, and practice time logs were analyzed by Pearson chi-square and student t-test.  P-values <0.05 were considered significant.  Results:  Forty residents presented for tutorials.  Fourteen (35%) reached the goal during the study period and they required between 1 and 21 (median: 1.5) practice sessions.                         * mean, SD Conclusion: Residents that achieved competence in laparoscopic intracorporeal suturing (as compared to those that did not) were 1) significantly more likely to have had 3 or more years of post-graduate training, 2) significantly more experienced with complex laparoscopic cases, and 3) sutured twice as fast at the time of their initial tutorial.     Met Goal n = 14(%)    Goal Not Met n =26(%) p Post Graduate Year 3- 5 12(86%) 2(8%) 0.01 Complex Lap. Cases* 23.4+/-19 9.5+/-12.5 0.01 Baseline Time (min)* 14.3+/-6.5 19.4+/-9.6 0.04  
  •  Baerg J, Ou  Thoracoscopic and Laparoscopic Placement of a Pleuro-peritoneal Shunt In a Patient with Congenital Lymphedema and a Symptomatic Pleural Effusion 3 min. Oral Poster presentation at International Pediatric Endosurgery Group MeetingPhoenix, AZ  April, 2009. ( 9/2008 - 4/2009 )
     ABSTRACT:       INTRODUCTION:   We present a case of endoscopy-guided placement of a pleuro-peritoneal shunt in a patient with primary lymphedema, multiple abdominal lymphoceles, an episode of spontaneous bacterial peritonitis and  recurring symptomatic  pleural effusions.CASE:  A fifteen year-old boy with primary lymphedema, had undergone multiple thoracenteses and chest tubes for a left pleural effusion.  An incision was made in the posterior axillary line at the sixth intercostal space.  The pleural portion of the shunt was placed in good position guided by the five millimeter, thirty-degree camera.    The shunt and pump chamber were tunneled under the skin.  A 5mm incision was made in the left upper quadrant, a purse string suture was placed in the posterior rectus sheath and the 5mm port was inserted into the abdomen under direct vision.   Pneumoperitoneum was obtained to a pressure of 13 mm Hg and the camera was inserted.  Multiple lymphoceles and   adhesions were identified. With laparoscopic guidance, an area was dissected in which to place the shunt.  Immediate good shunt function was observed.DISCUSSION:  This previously unreported use of endoscopy to successfully place a pleuro-peritoneal shunt, allowed a patient to be discharged from hospital free of oxygen and external tubes.    Information was obtained about the patient’s abdomen  which will guide future therapy.
  •  Baerg, Shores, Fung, Yanni, Tagge,  Deming   Weight Gain in Infants With GERD Managed with Medical Therapy or Fundoplication.  3 min. Oral Poster presentation at Canadian Association of Pediatric Surgeons.  Toronto, Canada         August   2008. ( 6/2006 - 8/2008 )
  •  Baerg, Taylor  A Laparoscopic Technique of Simultaneous Gastrostomy Placement and Inguinal Hernia Repair in a Neonate    Poster Presentation   International Pediatric Endosurgery Group, Los Angeles, March 2003. ( 5/2002 - 12/2003 )
     Baerg,  Taylor   Pediatric Endosurgery & Innovative Techniques. December 1, 2003:445- 449.     Laparoscopic Technique of Simultaneous Gastrostomy Tube Placement and Inguinal Hernia Repair in a Neonate (peer reviewed)
  •  Baerg, Kaban   Gastroschisis- A 10 Year Review    Oral Presentation- Canadian Association of Pediatric Surgeons   Vancouver, Canada   September   2002. ( 3/2001 - 9/2002 )
     Baerg, Kaban, Tonita, Pahwa, Reid      J Pediatr Surg. 2003  May;38(5):771-4.    Gastroschisis: A sixteen-year review.  Peer reviewed and published.
  •  Meyers, Baerg       Farm accidents in children: Eleven Years of Experience.  Oral presentation at Canadian Association of Pediatric Surgeons, Sept. 2000. ( 1/2000 - 5/2001 )
     Meyers, Baerg      J Pediatr Surg. 2001 May;36(5):726-9. Farm accidents in children: Eleven Years of Experience.
  Research Presentations -- National
  • Saleem Islam, Shawn St Peter, Cynthia Downard, Joanne Baerg, Steve Bruch, Faisal Qureshi, Paul Danielson, Elizabeth Renaud.  Contemporary Omphalocele Outcomes from a Multicenter Registry.  American Academy of Pediatrics, October 2013.

    ( 3/2014 )
  • Baerg J, Vannix R, Fam J, Taha A, Zouros A.  Cervical Spine Injuries in Children with Inflicted Trauma.  Podium Presentation: January 2014. American Colllege of Surgeons, So Cal Chapter.  Trauma Session.


    ( 3/2014 )
  • Shandee Hutson, MD1, Joanne Baerg, MD2, Sandhya Ramlogan, MD3, Adam Woelk, BS4, William Drake, MD3, Shawn St. Peter MD5, Andrew Hopper, MD1, and Donna  A Goff, MD,MS&a ( 3/2014 )

    High Prevalence of Pulmonary Hypertension Complicates Care of Infants with Omphalocele. A Multicenter Study.  American Heart Association. Dallas Texas, November 2013.

  • K Samakar MD, A Astudillo MD, M Moussavy MA, J Baerg MD, M Reeves MD PhD,C Garberoglio MD Evaluating Virtual Reality Simulator Training on Surgical Residents Perceptions of Stress: A Randomized Controlled Trial.  Poster Presentation. SAGES.  San Diego CA. March 2012 ( 3/2012 - 11/2012 )
  • Baerg, Deming  The Contribution of GERD to Weight Loss in NICU Infants    Podium Presentation (3 minutes)  American Pediatric Surgery Association   Orlando, Florida  May 22, 2010 ( 5/2010 )
    Purpose:              We sought to identify significant associations between gastroesophageal reflux disease (GERD) and weight loss in neonatal intensive care unit (NICU) infants. Methods:              After Institutional Review Board approval, infants born between January 2004 and December 2006, investigated by 24-hour pH-probe before age six months, were reviewed retrospectively. GERD was present if the pH < 4 for over 5% of 24 hours.  We examined growth curves at the initial pH-probe, 6 months later, and December 2009.  At the six-month evaluation, we compared infants who lost to infants who gained.  Logistic regression identified subgroups associated with weight loss independent of GERD.  Results:             Follow-up was complete for 191, 48(25.1%) lost and 143(74.9%) gained.  GERD was present in 87/191(45.5%), 31(35.6%) underwent fundoplication, 56(64.4%) received anti-reflux medications. Weight loss occurred in 21/87(24.1%) and was not from GERD in 20/21(95.2%). Between 6-30 months (median:  10 months) after their initial probe, 5/31(16.1%) fundoplication patients were vomiting, but gaining weight.  A pH-probe confirmed GERD.             GERD was absent in 104/191(54.5%). Weight loss occurred in 27/104(26.0%) and was not from GERD in 20/27(74.1%). Between 6-31 months (median: 11 months) after a negative probe, 7/27(26.0%) were vomiting and losing weight.  A pH-probe confirmed GERD.             Infants unable to feed orally (OR:2.68(95%CI:  1.24-5.85)), or with a genetic syndrome (OR:13.56(95%CI:  4.56-40.29)), lost independent of GERD. Conclusions:              If treated, GERD is not associated with weight loss in NICU infants.  Despite a negative pH-probe, pediatricians should inquire about GERD symptoms, and restudy infants before weight loss occurs.  Infants with inability to feed orally or genetic syndromes lose weight, independent of GERD.   
  • Baerg, Tai, Tagge, Deming. GERD in NICU Infants:  Is a 24-hour pH Probe Study Always Necessary Prior to Gastrostomy Placement?       Podium presentation (5 min) American College of Surgeons, Santa Barbara, CA               January 23, 2010 ( 1/2010 )
  •  Baerg, Elihu Chronic Intestinal Pseudo-obstruction in Children  American College of Surgeons- Jan 19-21, 2007.  Santa Barbara, CA  oral presentation ( 7/2006 - 1/2007 )
     Chronic Intestinal Pseudo-obstruction in Children Joanne Baerg MD, Arvand Elihu MD    Loma Linda University Children’s Hospital       Background: The aim of this study was to report the presentation and outcome of 20 consecutive children with the syndrome of chronic intestinal pseudo-obstruction between 1995-2005.  Methods:IRB approval was obtained.  Charts of patients <17 years with recurrent signs of intestinal occlusion in the absence of identifiable obstruction were reviewed.  Hirschsprung’s disease was excluded.Results:Twelve girls (60%) and 8 boys (40%) were identified.  Twelve (60%) presented before one year (range: 3 months-10 years).  Three underwent ileostomy (15%).  Follow-up ranged from 1.5-17 years (mean -9years).  One boy suffered Munchausen’s by proxy.  The remaining 19 were categorized:  1)  Three (15%) had pathologic evidence of myopathy(2) and neuropathy (1).  2)  Twelve (60%) had non-specific intestinal failure, 8(66%) were neurologically impaired and had GERD.  The intestinal failure worsened after Nissen fundoplication in 3 (25%).  3)  Four (20%) actually had a slowly evolving mechanical obstruction which resolved after surgery.  Overall mortality was 20% (4/20).  Presently, 10 (50%) tolerate enteral feeds and 6 (30%) require parenteral nutrition.   Conclusion:Three children (15%) had pathologic evidence of pseudo-obstruction.  Intestinal failure can occur despite normal histology.  A slowly evolving mechanical obstruction can mimic pseudo-obstruction and should be eliminated from the diagnosis.  
  • J. Baerg MD and J. Chiriano MD. "A Puzzling Case of Premature Menarche in a 7 year old Girl." American College of Surgeons-Ped. Surgery Section. Santa Barbara, CA  Oral presentation. ( 1/2006 )
  • Dr. J. Baerg. "Neonatal Intestinal Obstruction." Grand Rounds. Parkview Hospital, Riverside ( 4/2005 )
  • J Baerg. "Management of Gastroschisis." Grand Rounds. St. Bernardine's Hospital, San Bernardino ( 2/2005 )
  •  Baerg, Klooster,  Zuppan Biliary Atresia- A Fifteen Year Review      Poster Presentation,   American Academy of Pediatrics.   New Orleans Nov. 2003. ( 3/2001 - 6/2004 )
     Baerg, Zuppan, Klooster                         J Pediatr Surg  2004; Jun  39(6): 800-3 Biliary Atresia: A Fifteen Year review of Clinical and Pathologic Features Associated with Liver Transplant  Published in peer reviewed journal.
  •  Baerg, Curtis   Beware of Innocuous Air Rifle Injuries   American College of Surgeons,  Jan 2003   Santa Barbara, CA  Oral presentation. ( 1/2002 - 1/2003 )
     J. Curtis MD * resident in surgery (presenter) J. Baerg MD    (senior colleague)   Dept. of Pediatric Surgery, Loma Linda University Children’s Hospital Rm. 21111, Coleman Pavilion, 11175 Campus St. Loma Linda, CA                92354     Beware of “Innocuous” Air Rifle Injuries     Two toddlers, ages 3 and 5 respectively, sustained intentional close range air rifle injuries to the anterior abdominal wall. (0.177 caliber ball bearing and low velocity weapons- 280 feet per sec.)   One patient was left unsupervised with an older sibling and one was the victim of child abuse. Each presented with a 3mm opening on the anterior abdominal wall and no exit wound. Vital signs remained within normal limits throughout the assessment and no other injuries were noted. Triple contrast abdominal CT scans and serial abdominal X-rays of each patient remained completely unremarkable. In spite of normal investigations, serial abdominal exams revealed peritoneal irritation within a short period of time after arrival.  Laparotomy was performed in each case and findings will be described.  The cases illustrate the potential lethality of air rifles and the importance of accurate, frequent clinical exams over radiological studies in order to prevent missed injuries.     Address correspondence to Dr. Baerg Email:       jbaerg@som.llu.edu Phone:      909 558 4619, Fax:  909 558 0236
  •  Baerg J.      Congenital Pancreatitis  Oral presentation    American College of Surgeons    Santa Barbara, CA     Jan 2002 ( 3/2001 - 1/2002 )
  Research Presentations -- Regional
  • Adventist Post graduate Conference:  March 2014. Clinical Research in Pediatric Surgery 15 minutes Podium presentation ( 3/2014 )
  • Hutson S, Baerg J, Woelk A,  Lavery, A, Hopper A, Goff, D.A.  Pulmonary Hypertension in Infants with Omphalocele. Presented at Western Society for Pediatric Research, Monterey CA 2013.

    ( 3/2014 )
  • APC poster March 2014: 

    Baerg J, Vannix R, Fam J, Taha A, Zouros A.  Cervical Spine Injuries in Children with Inflicted Trauma. 

    ( 3/2014 )
  • Baerg J, Michelotti M, Garberoglio C, Reeves M.  The Promotion of Laparoscopic Suturing Competence Among Residents. 5 min podium presentation at The American College of Surgeons.  Santa Barbara, CA.  January 2012 ( 1/2012 - 11/2012 )
  • Baerg, Kanthimathinathan, Moores Late Presenting Congenital Diaphragmatic Hernia:  A 21 year Single Center Review Podium Presentation (5 min)at the Pediatric Surgery Section of ACS, Santa Barbara, CA January 2011. ( 1/2011 )
  Poster Presentation
  • Baerg J, Astudillo A, Aragon R, Michelotti M.  Ovarian Sparing Laparoscopic Teratoma Excision. International Pediatric Endosurgery Group. Beijing, China. 2013.  Published in J of Adv Laparoend Techniques

    ( 3/2014 )
  • Hutson S, Baerg J, Woelk A,  Lavery, A, Hopper A, Goff, D.A.  Pulmonary Hypertension in Infants with Omphalocele. Pediatric Academic Society. Washington DC. 2013.


    ( 3/2014 )
  • Baerg J,  Woelk A ,  Longshore S ,  Thorpe  D   Incidence and Factors Associated with Non-Survival in Infants with Omphalocele Pediatric Academic Society. Washington DC. 2013 ( 3/2014 )
  • Longshore S,  Rodriguez S, Cubas R, Siavanandam A, Wanis M, Baerg J, Tagge E, Moores D. Oral Atropine:  A Cure for Persistent Post-Pyloromyotomy Vomiting.   Pacific Association of Pediatric Surgeons, Sydney Australia. 2013

    ( 3/2014 )
  • Samakar K, Astudillo JA,  Moussavy M,  Baerg J, Reeves ME, Garberoglio C. Evaluating Virtual Reality Simulator Training on Surgical Residents Perceptions of Stress: A Randomized Controlled Trial.  Society of American and Gastrointestinal Surgeons (SAGES)  San Diego CA, 2012.

    ( 3/2014 )
  • Systemic Hypotension following pediatric surgical procedure including patent ductus arteriosus   ligation: the role of adrenal immaturity               PRINCIPAL INVESTIGATOR: Thurman Merritt MD               T Solomon MD,  J Baerg MD, G Gollin MD, M Goldstein MD, R Peverini MD, Arlin Blood PhD               Poster Presentation at Pediatric Academic Society. May 2011 Denver Colorado. ( 11/2011 )
  •  Sept. 2011:  International Conference on Residency Education:  3 min oral and Poster presentation; Development of a Successful Laparoscopy Curriculum.  J Baerg MD, K Samakar MD, JA Astudillo MD, ME Reeves MD PhD ( 1/2011 - 9/2011 )
  • Baerg, Deming             The Contribution of GERD to Weight Loss in NICU Infants             Poster Presentation  (Pediatrician Audience)             Pediatric Academic Society             Vancouver, Canada             May 1-4, 2010 ( 5/2010 - 4/2010 )
  Presentations given to non-academic audiences
  •  Presentation for Redlands First Baptist Church  Parenting Network.    Time Management for Really Busy Families. Prioritizing Family, Work, Recreation and Relationships       May 16, 2008 ( 3/2008 - 5/2008 )
  • Dr. J. Baerg. "American Health Insurance Policy, Implications for a Healing Ministry." Church Presentation. Redlands First Baptist Church ( 5/2005 )