Loma Linda University

Enrollment Information
Call us at: 909-558-1000

Faculty Directory
  
Joanne Baerg, MD
Associate Professor, Surgery
School of Medicine
Associate Professor, Pediatrics
School of Medicine
Publications    Scholarly Journals--Submitted
  • Independent Predictors of Mortality in Infants with Omphalocele

    Joanne E. Baerg MD¹
    , Donna Thorpe PhD¹, Adam Woelk MD¹, Nicole E. Sharp MD¹, Sandhya Ramlogan MD², William Drake MD², Shandee Hutson MD¹, Donna Goff MD MS¹, Andrew Hopper MD¹, Shawn D. St. Peter MD²
    Submitted to Hospital Pediatrics- February 2014

    ( 3/2014 )

    Abstract

    Objective:

                Survival of infants with omphalocele may improve as predictors of mortality are understood.  The objective of this study was to identify independent predictors of mortality in infants with omphalocele.

    Methods: 

    Infants with omphalocele, from two children's hospitals, born between January 1992 and June 2012, with follow-up to December 2012, were retrospectively reviewed. Survivors and non-survivors were compared by t-tests for continuous and Pearson chi-square tests for categorical variables.  A P-value less than 0.05 achieved significance.  Logistic regression evaluated for variable independence.

    Results:

    There were 51 infants identified, 13 died (25%) and 38 survived (75%).  The median time to death for non-survivors was 34 days (range:  4 - 408 days). The median follow-up time for the cohort was 1.5 years (range:  0.01-15 years) and for survivors it was 2.6 years (range:  0.08 – 15 years).  All 38 survivors (100%) were repaired:  30/38 (79%) before discharge and  8/38 (11%) later during an elective hospitalization.

    Factors associated with mortality were: pulmonary hypertension (p <0.013), respiratory failure at birth  (p <0.001), lower Apgar scores (p <0.001), sac rupture (p = 0.039) and defects containing 75% liver (p = 0.012). Survivors required significantly fewer days of TPN (p<0.001) and achieved oral feeding (p<0.001).  Logistic regression revealed:  respiratory failure at birth (OR:  14.8 (95%CI: 2.5-85.0)) and pulmonary hypertension diagnosed between day of life 2-7 (OR:  6.4 (95%CI:  1.1-39.0)) were independently associated with mortality.

    Conclusion:

    Respiratory failure at birth and pulmonary hypertension diagnosed between day of life 2-7 are independent predictors of mortality in infants with omphalocele.

  • J Baerg, G Gollin.
    THE LAPAROSCOPIC DUODENO-DUODENOSTOMY SIMULATOR: A MODEL FOR CUSTOMIZABLE MINIMALLY INVASIVE SURGERY TRAINERS Submitted to IPEG and Journal of Advanced Laparoendoscopic Techniques.

    ( 3/2014 )

    Introduction:  Simulator training is an important step toward proficiency in minimally invasive surgery (MIS) for pediatric surgeons.  MIS repair of duodenal atresia requires suturing skills that are difficult to acquire.  We sought to develop a prototype of an inexpensive, synthetic, and customized MIS simulator for laparoscopic duodeno-duodenostomy.

     

    Methods:  Two pediatric surgeons, in cooperation with a University Bioengineering Department, designed and developed a synthetic model to simulate laparoscopic duodenal atresia repair in an infant.

     

    Results:  The simulator was constructed in three parts: organ construction, training box construction and assembly.  

    Organ construction:  Solid molds of small intestine, duodenum, stomach and liver were designed in SolidWorks software in ABS plastic using the 3D printer.  The size of each mold was designed to be dimensionally accurate to life-sized infant organs.  TAP premium latex rubber was then dispersed over the plastic molds to construct the organs. The duodenal segments included a layer of thin gauze sandwiched between layers of latex. Training box construction:  The box was modeled after the body cavity of an infant, from the lower neck to the top of the thighs.  The interior volume mimics the pneumoperitoneum of an infant abdomen during laparoscopic surgery.  After constructing a Styrofoam top and bottom frame template that simulated the top and bottom of the infant body, fiberglass resin was painted over the template to construct the body cavity. Three holes designating the placement of a grasper, a needle driver and an endoscope were cut from the top frame.  Top and bottom frames were secured to each other.  Reusable rubber grip was secured over the top frame so the laparoscopic instruments could be placed through it.  Assembly:  Organs were secured in the box with Velcro.  The small intestine, duodenum and stomach were placed in the bottom frame and the liver was placed inside the top frame of the body cavity. A silicone rubber sheet covered the top frame.  The simulator was then ready for placement of the laparoscopic instruments. 

    The simulated duodeno-duodenostomy was judged to be realistic by the surgeons who trialed the simulator.  The material was durable and did not tear or deform after multiple anastomoses.

    Conclusion:  An inexpensive, life-sized and durable synthetic simulator for MIS duodeno-duodenostomy was constructed.  This serves as an initial proof of concept that customizable simulators of pediatric MIS procedures can be constructed using 3-D printing technology and TAP latex to construct organs.  The development of operation-specific simulators has the potential to speed the safe and efficient integration of rare pediatric MIS procedures into practice.

     

     

  Scholarly Journals--Published
  • Astudillo A, Michelotti M, Aragon R, Baerg J.  Ovarian Sparing Laparoscopic Teratoma Excision.  J of Laparoendo and Adv Surg Tech 2013 23; 12: 91-92

    ( 3/2014 )
  • Baerg J, Namm J, Astudillo JA, Wong J, Michelotti M, Gollin G. Laparoendoscopic excision of sternal subcutaneous dermoids in children.  Surg Endosc. 2013 Feb; 27(2):685-8. ( Epub 2012 Oct 6.)

    ( 3/2013 )
  • *Baerg J, Denmark K, Longshore S.  “Pediatric Trauma Interprofessional Simulation- 5 Year-Old Pedestrian Struck by a Motor Vehicle”successfully passed the peer-review process and has been officially indexed, formatted, and published. MedEdPORTAL; 2013. Available from: www.mededportal.org/publication/9323.

    ( 3/2013 )
  • Baerg J, Michelotti M, Garberoglio C, Reeves ME. The Promotion of Laparoscopic Suturing Competence Among Residents.   Am Surg. 2012  Sep;78(9):1012-4.  ( 11/2011 - 11/2012 )
     
  • Baerg J, Namm J, Astudillo JA, Wong J, Michelotti M, Gollin G.  Laparoendoscopic excision of sternal subcutaneous dermoids in children.  Surg Endosc. 2012 Oct 6. [Epub ahead of print] No abstract available. ( 11/2011 - 11/2012 )
     
  • Baerg JE,  Thorpe D, Bultron G, Vannix R, Knott EM, Gasior AC, Sharp SW,Tagge E., St. Peter SD  A Multicenter Study of the Incidence and Factors Associated with Redo Nissen Fundoplication in Children.J Pediatr Surg 2013 June;8(6):  1306-1311.

     

    ( 3/2012 )
  • St. Peter S.D., Valusek, P.A., Hill, S., Wulkan, M.L., Shah, S.S., Martinez-Ferro, M., Bignon, H., Laje, P., Mattei, P.A., Graziano K.D., Muensterer, O.J., Pontarelli, E.M, Nguyen N.X., Kane T.D., Qureshi F.G., Calkins, C.M., Leys, C.M., Baerg, J.E., Holcomb, G.W. III. Laparoscopic Adrenalectomy In Children: A Multicenter Experience. Journal Laparoendoscopic and Surgical Techniques (7):647-9. J Laparoendosc Adv Surg Tech A.<http://www.ncbi.nlm.nih.gov/pubmed/21777064#> 2011 Sep;21(7):647-9. Epub 2011 Jul 21. Laparoscopic adrenalectomy in children: a multicenter experience. ( 6/2011 ) Link...
     
  • Baerg J, Ou H.
    Baerg J, Ou H.   Endoscopic Placement of a Pleuroperitoneal Shunt.  Journal of Lymphoedema, 2011, vol. 6, no. 1.(complete manuscript) ( 4/2011 )
     
  • Ejike JC, Newcombe J, Baerg J, Bahjri K, Mathur M. Understanding of Abdominal Compartment Syndrome among Pediatric  Health Care Providers.  Critical Care Research and Practice, Volume 2010 (2010), Article ID 876013, 6 pages. ( 6/2011 - 12/2010 )
  • Baerg J, Michelotti M, Tamez A Jose, Reeves ME. Laparoscopic Intracorporeal Suturing Among Residents:  Can We Predict Success?  J of Laparoscopic and Adv Surg Techniques, Volume 20, Suppl 1, 2010, S77. ( 6/2011 - 12/2010 )
  • Baerg J, Ou H. Thoracoscopic and Laparoscopic Placement of a Pleuro-peritoneal Shunt In a Patient with Congenital Lymphedema and a Symptomatic Pleural Effusion J of Laparoendoscopic and Advanced Surgical Techniques, volume 19: 2, p.292.  2009  (published abstract) ( 9/2008 - 9/2009 )
     
  • Baerg J, Zuppan C, Klooster M:  Billiary atresia -- a fifteen-year review of clinical and pathologic factors associated with liver transplantation.  J Pediatr Surg. 2004 Jun:39(6):800-3. ( 6/2004 )
  • Gollin G, Moores D, Baerg JE:  Getting residents in the game: an evaluation of general surgery residents'' participation in pediatric laparoscopic surgery.  J Pediatr Surg. 2004 Jan;39(1) 78-80. ( 3/2004 - 1/2004 )
  • Baerg J, Taylor R.    Pediatric Endosurgery & Innovative Techniques. December 1, 2003:445- 449.     Laparoscopic Technique of Simultaneous Gastrostomy Tube Placement and Inguinal  Hernia Repair in a Neonate ( 1/2002 - 12/2003 )
     
  • Gollin G, Abarbanell A, Baerg, JE:  Peritoneal drainage as definitive management of intestinal perforation in extremely low-birth weight infants.  J Pediatr Surg. 2003 Dec;38(12):1814-7. ( 3/2001 - 12/2003 )
  • Baerg, Kaban, Tonita, Pahwa, Reid J Pediatr Surg. 2003 May;38(5):771-4. Gastroschisis: A sixteen-year review. ( 5/2000 - 5/2003 )
     
  •  Prince, Baerg Janner     Pediatr Infect Dis J. 2002 Oct;21(10):986, 990-1  Anterior Chest Wall Fistula in a Fourteen-Year-Old.   ( 5/2002 - 10/2002 )
     
  • Meyers S., Baerg JE        J Pediatr Surg. 2001 May;36(5):726-9. Farm accidents in children: Eleven Years of Experience ( 1/2001 - 5/2001 )
  •   Scholarly Journals--Accepted
    • 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 )

      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.

      Abstract
    • 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 )

      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 )
      [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.
    • [2010] [235] 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 )
      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.
      E-PAS2010235