Baerg J, Ou H.
Baerg J, Thorpe D, Vannix R, Knott EM, Gasior AC, Sharp SW, E Tagge, St. Peter SD
A Multicenter Study of the Incidence and Factors Associated with Non-Survival After Nissen Fundoplication in Children.
In Press- Accepted for Publication- European Journal of Pediatric Surgery February 2014
( 3/2014 - Present )
Purpose: The objective was to identify factors associated with non-survival after Nissen fundoplication in children.
Methods: After IRB approval, children from two centers with fundoplications performed between January 1994 and December 2010 were retrospectively reviewed. Inclusion required complete data and follow-up to October 2011. Variables were compared using t-tests for continuous and chi-square tests for categorical variables to identify factors associated with non-survival. Patient factors present before the first fundoplication were analyzed. Surgical factors were surgical complications, open fundoplications and redos. Logistic regression evaluated for independence.
Results: 823 children were identified, 412 were included and 63 died (15.3%). The median follow-up was 3.7 years (mean: 4.5+/-3.2). For non-survivors, the median time to death after fundoplication was 0.5 years (mean: 1.1+/-1.5). Significant factors after univariate analysis were: surgical complications (p=0.001), female gender (p=0.001), neurologic impairment (p=0.010), and fundoplication before 18 months (p=0.035). Independent predictors were: surgical complications, OR: 3.30 (95% CI: 1.31-8.29), neurologic impairment, OR: 2.58 (95% CI: 1.38-4.83), fundoplication before 18 months, OR: 2.46 (95% CI: 1.23-4.94), and female gender, OR: 2.25 (95% CI: 1.26-4.0).
Conclusion: After Nissen fundoplication in children, surgical complications, neurological impairment, fundoplication before 18 months, and female gender are associated with non-survival. Most die within 2 years following operation.
Baerg J, Woelk A, Longshore S, Thorpe D
Incidence and Factors associated with Non-survival in Infants with Omphalocele www.abstracts2view.com PAS 3839.662
( 3/2013 - Present )
Title: INCIDENCE AND FACTORS ASSOCIATED WITH NON-SURVIVAL IN INFANTS WITH OMPHALOCELE
Joanne E Baerg, MD1, Adam Woelk, MD1 and Donna Thorpe, PhD1. 1Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, 92354, United States.
Background: Little is known about omphalocele patients and survival.
Objective: To determine the estimated mean survival time for a series of omphalocele patients and identify factors associated with non-survival.
Design/Methods: After IRB approval, a retrospective review was conducted of omphalocele patients between January 1992 and August 2011. Survivors and non-survivors were compared to identify factors associated with non-survival. Infants with complete follow-up to March 2012 and completed repair were included. The cumulative incidence of survival was analyzed by Kaplan-Meier method. Factors included were: gender, gestational age, birth weight, weight-length z-score, APGARs at 1 and 5 minutes, days of ventilation, abnormal chromosomes, persistent pulmonary hypertension (PPHN), congenital heart defects, brain anomalies, defects containing 75% liver, intestinal surgeries, days to goal feedings and days of total parenteral nutrition (TPN). Factors were compared by chi-square tests for categorical and t-tests for continuous variables. A p-value less than 0.05 was considered significant.
Results: Forty-eight infants were included. Follow-up ranged from 0.5 to 20 years (median:3.5 years). Fourteen (29.2%) died, all during their initial hospitalization. The mean survival time for non-survivors was 0.27 years (SD 0.33) and mean defect size was 30.5 cm² (range 6-94cm²). Thirty-four survivors (70.8%) underwent repair: 12 (35.3%) infants prior to discharge (mean defect size: 8.9cm² (range: 4-25cm²)) and 22 (64.7%) infants after discharge during an elective hospitalization (mean defect size: 38.3²) (range: 8-120cm²). The estimated mean survival time was 14.3 years (SD 1.3)(95% CI:11.8-16.9) Factors associated with non-survival were: abnormal chromosomes (p=0.013), PPHN (p=0.043), greater ventilator days (p=0.004), low APGARs at 1 (p=0.003),and 5 minutes (p=0.010), and failure to achieve goal feedings (p<0.001). Survivors achieved goal feedings faster than non-survivors (mean: 8.9 days (SD 8.3) vs. 73.5 days (SD 122.6)) (p=0.002) and required less TPN ((mean: 17.5 days) (SD 17.9) vs. 76.3 days (SD 87.2)) (p=0.032).
Conclusions: The estimated mean survival time for omphalocele patients is 14.3 years. Non-survivors die of comorbidities in the first months of life. Abnormal chromosomes, PPHN, low APGARs, failure to achieve goal feedings and a greater TPN requirement are associated with non-survival. Infants with large defects survive if they have few comorbidities, and achieve goal feedings.
Hutson S, Baerg J, Woelk A, Lavery A, Hopper AO, Goff D. Pulmonary Hypertension in Infants with Omphalocele. www.abstacts2view.com PAS 4517.298
( 3/2013 - Present )
[4517.298] Pulmonary Hypertension in Infants with Omphalocele
Shandee Hutson, Joanne Baerg, Adam Woelk, Adrian Lavery, Andrew Hopper, Donna Goff. Neonatology, Loma Linda University Children's Hospital, Loma Linda, CA; Pediatric Surgery, Loma LInda University Children's Hospital, Loma Linda, CA; Pediatric Cardiology, Loma Linda University Children's Hospital, Loma Linda, CA; Loma Linda University School of Medicine, Loma Linda, CA.
BACKGROUND: Many infants born with an omphalocele present with significant respiratory distress at birth requiring mechanical ventilatory support. Some infants present with clinical evidence of pulmonary hypertension which may complicate their overall outcome. To date, no data exist on the prevalence of pulmonary hypertension in this cohort of infants.
OBJECTIVE: To describe the prevalence of pulmonary hypertension among infants with an omphalocele and identify risk factors associated with the presence of pulmonary hypertension.
DESIGN/METHODS: A total of 33/46 (72%) infants with omphalocele admitted to the LLUCH NICU between 1994-2011 had echocardiograms available for review. Demographic data and clinical characteristics were collected by retrospective chart review. Echocardiogram(s) were reviewed by a single pediatric cardiologist for pulmonary hypertension based on presence of flattening of the interventricular septum and/or tricuspid regurgitant jet with estimated RV pressure >40mmHg. Data were summarized and compared for the pulmonary hypertension versus the no pulmonary hypertension cohort using Fisher's exact test, two-sample t-test, or Mann-Whitney test as appropriate. Significance was set at p<0.05.
RESULTS: Pulmonary hypertension was diagnosed in 23/33 (70%) infants with an omphalocele. Most infants with pulmonary hypertension were female 14/23 (61%) with mean gestational age 35.7 +/- 3.4 weeks. Presence of liver in the omphalocele sac was more prevalent in the pulmonary hypertension cohort compared to the no pulmonary hypertension cohort, 18/23 (78%) vs 3/10 (30%), respectively, p= 0.02.
  GERD in NICU Infants: Is a 24-Hour pH Probe Study Always Necessary Prior to Gastrostomy Placement?
Joanne E. Baerg, Cindy Tai, Edward Tagge, Douglas Deming. Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA; Neonatology, Loma Linda University Children's Hospital, Loma Linda, CA. ( 3/2010 - Present )
BACKGROUND: NICU infants who require a gastrostomy, are frequently evaluated for GERD by 24-hour pH probe, despite the absence of symptoms.
OBJECTIVE: 1) To identify the incidence of GERD in NICU infants requiring gastrostomy. 2) To identify factors associated with GERD. 3) To evaluate growth curves and identify development of GERD during follow-up.
DESIGN/METHODS: An IRB approved retrospective review was carried out between January 2004 and December 2006. 100 NICU infants under age 6 months, underwent a 24-hour pH probe prior to gastrostomy placement. Growth curves were reviewed at time of probe, 6 months later and at study completion (2-5 years follow-up). Data were analyzed by Chi-square and logistic regression. P values </= 0.05 were considered significant.
RESULTS: Thirty-four infants (34%) had GERD. Factors associated with GERD on univariate analysis were: neurologic impairment (p=0.001), prematurity (p=0.001), aspiration symptoms (p=0.002), intraventricular hemorrhage (p=0.002), seizures (p=0.005), and vomiting (p=0.005). Independent predictors were: neurologic impairment, OR 7.1 (95%CI 1.9-26), prematurity, OR 4.6 (95%CI 1.7-12.8), aspiration, OR 3.6 (95%CI 1.1-12.0), and vomiting, OR 3.4 (95%CI 1.4-8.0). Ninety-two infants(92%) had complete follow-up. Thirty (33%) had GERD and 62 (77%) did not. Despite initiation of therapy for GERD, 3/30 had recurrent symptoms of GERD but were growing well. All 62 who were GERD negative underwent only gastrostomy. Fifty-two of 62 continued to be symptom free and maintained their growth curves. Ten of 62 began vomiting 3-24 months after the initial probe (median: 7 months) and were restudied. All had GERD and 8 were losing weight.
CONCLUSIONS: The incidence of GERD in NICU infants undergoing gastrostomy was 34%. Evaluation in this group should be directed to infants with neurologic impairment, prematurity, aspiration or vomiting. Infants without these factors may be over studied. Those without GERD at the time of initial gastrostomy, who subsequently develop GERD symptoms, should be re-evaluated promptly before they show evidence of failure to thrive.