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Joanne Baerg, MD
Associate Professor, Surgery
School of Medicine
Associate Professor, Pediatrics
School of Medicine
Publications    Scholarly Journals--Submitted
  •  

    HIGH PREVALENCE OF PULMONARY HYPERTENSION COMPLICATES CARE OF INFANTS WITH OMPHALOCELE (archdischild-2015-309317) has been submitted by Dr. Shandee Hutson to Archives of Disease in Childhood.

    You are listed as a co-author for this manuscript. The online peer-review system, ScholarOne Manuscripts,

     

     

    ( 7/2015 )
  • Laparoscopic and Transanal Repair of Rectal Atresia.
    J  Baerg  MD, E  Perrone MD

    International Pediatric Endosurgery Group  April 2015, Nashville TN.

    Video presentation. 4 min video presentation.

    ( 4/2015 )
    Submitted to VIDEOSCOPY
  Scholarly Journals--Published
  • Outcomes after Pediatric Fundoplication: Defining the Redo Population
    Baerg JE*1, Perrone EE1, Vannix RA1, Thorpe DL1, Gasior A2 and St Peter SD2
    ¹Loma Linda University and Children’s Hospital Loma Linda, CA, USA  ²Children’s Mercy Hospital, Kansas City, MO, USA
    Journal of Paediatrics and Neonatal Disorders
    Vol 1/ Issue 1  Open access

     

    ( 6/2015 )

     

    Journal of Paediatrics and Neonatal Disorders

    Volume 1 | Issue 1

    Open Access

    Research Article

    Outcomes after Pediatric Fundoplication: Defining the Redo Population

    Baerg JE*1, Perrone EE1, Vannix RA1, Thorpe DL1, Gasior A2 and St Peter SD2

    ¹Loma Linda University and Children’s Hospital Loma Linda, CA, USA

    ²Children’s Mercy Hospital, Kansas City, MO, USA

    *Corresponding author: Baerg JE, MD, Associate Professor, Pediatric Surgery, Rm. 21111, Coleman Pavilion, 11175 Campus St., Loma Linda, CA 92354, Fax: 909 558 7978, Tel: 909 558 4619, E-mail: jbaerg@llu.edu

    Citation: Baerg JE, Perrone EE, Vannix RA, Thorpe DL, Gasior A, et al. (2015) Outcomes after Pediatric Fundoplication: Defining the Redo Population. J Paedatr Neonatal Dis 1(1): 102

    Abstract

    Objective: The aims were to compare outcome variables in children with gastroesophageal reflux disease (GERD) and one Nissen fundoplication to children with redo fundoplications and define the pediatric redo population.

    Methods: After IRB approval (#5100277), a case control study was conducted of children younger than 18 years, from two children’s hospitals, with one Nissen fundoplication (control group) or a redo performed between January 1995 and March 2011. Complete data were collected by phone calls to caregivers in December 2012. Only redo operations performed after recurrence of GERD symptoms and wrap herniation into the mediastinum confirmed by contrast radiograph were included. To define the redo population, variables present before initial fundoplication, and outcome variables identified in December 2012, were compared. Continuous variables were analyzed by t-tests and categorical variables by chi-square tests. Logistic regression evaluated variable independence.

    Results: The families of 212 children were contacted (54% male), 181 had one fundoplication (85.4%) and 31 had redos (14.6%). The median follow-up time for controls was 3.6 years (range: 0.9-16 years). The median time to first redo was 17 months (range: 1-108 months) and to second redo for 3/31 (9.7%), it was 32.5 months (range: 23-69 months). A significantly greater number with redos, could not feed orally prior to undergoing their first Nissen fundoplication (p=0.003). At follow-up evaluation, children with redos had significantly more hospital admissions for pneumonia (p=0.02), vomiting and retching (p=0.01), gastrojejunal feeding tubes (p=0.01) and wrap herniation on contrast radiograph (p=0.01). Logistic regression revealed vomiting, OR: 3.4 (95% CI: 1.4-8.3) and retching, OR: 3.8 (95% CI: 1.6-9.2) were independently associated with the redo population.

    Conclusion: At follow-up evaluation, vomiting and retching are independent factors that define the redo population. Significantly more children with redos are fed by gastrojejunal feeding tubes because the redo fails to control their GERD symptoms.

    Keywords: Redo Nissen fundoplication; Pediatric gastroesophageal reflux disease

    List of abbreviations: GERD: Gastroesophageal reflux disease; ALTE: Acute life threatening event; BMI: Body mas

    Introduction

    Children with complications of gastroesophageal reflux disease (GERD) frequently undergo Nissen fundoplication. There is significant heterogeneity among pediatric GERD studies [1]. Surgical treatment for GERD is reported to improve quality of life, especially for neurologically impaired children [2,3]. Despite initial symptomatic relief, however, the incidence of redo operation after fundoplication is reported between 1.7 and 18 percent [3-6]. Little is known about the outcome for children with GERD that require a redo fundoplication. The aims of this study were to compare outcome variables in children with one Nissen fundoplication for gastroesophageal reflux disease (GERD) to those with redo operations, define the pediatric redo population and make clinical recommendations.

     

  • Factors Associated with Mortality After Nissen Fundoplication in Children.
    Baerg J,
    Donna Thorpe Ph.D.Alessandra Gasior D.O. Rosemary Vannix N.P.
    Edward Tagge M.D. Shawn D. St. Peter M.D.    Eur J Pediatr Surg 2015 Jun; 25(3) :  L77-83  Epub:  2014 May 2

    ( 5/2014 )

    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.

  • 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...
     
  • 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 )
    J. Chiaka Ejike, MD, FAAP1   Jennifer Newcombe, NP2    Joanne Baerg, MD3    Khaled Bahjri, MD, MPH4    Mudit Mathur, MD, FAAP1Background: ACS is well described in the adult, trauma and surgical patient population. Very little literature exists with regards to the pediatric population. The sparse reporting of it in the pediatric literature may be a reflection of a decreased awareness among pediatric health care providers.   Aim: To assess current knowledge and ability to identify ACS among pediatric heath care providers.  Design: A brief written survey administered as a questionnaire.    Subjects: Pediatric health care providers   Method: A questionnaire was distributed to nurses attending a national nursing critical care meeting and at an international pediatric critical care conference.  Results: Forty-six percent of 1107 questionnaires were completed and returned. The majority of participants included general Pediatricians, Pediatric Intensivists, Pediatric Nurses and others. Eighty-eight percent worked in an intensive care setting and 80% worked in a tertiary hospital setting. Seventy-seven percent of participants had heard of ACS. Participants working in an ICU or tertiary care setting were more likely to be aware of ACS. The IAP thresholds for defining ACS were variable among participants. About one-quarter of participants never measured IAP but when it was measured the method used was the intra-vesicle method. Two thirds of those who were aware had actual experience in managing a child with ACS.    Conclusion: Awareness and recognition of ACS needs to be further promoted among pediatric health care professionals and there needs to be more clarity in the definition ofACS in children. Patients at risk for developing IAH and ACS need to be monitored using more objective techniques more routinely according to the consensus recommendations by the WSACS.
  • Baerg J, Ou H.   Endoscopic Placement of a Pleuroperitoneal Shunt.  Journal of Lymphoedema, 2011, vol. 6, no. 1.(complete manuscript) ( 4/2011 )
     
  • 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
  • Pulmonary Hypertension in Infants with Omphalocele



    Joanne E. Baerg MD¹
    , Donna Thorpe PhD¹, Nicole E. Sharp MD¹, Sandhya Ramlogan MD², Shandee Hutson MD¹, Donna Goff MD MS¹, Andrew Hopper MD¹, Shawn D. St. Peter MD²

    ACCEPTED for publication:  Journal of Neonatal and Perinatal Medicine: June 2015
    JNPM 915011 - Final Acceptance

    Dear Dr. Baerg,

    We are pleased to inform you that your manuscript JNPM 915011 has been approved for publication. A few minor edits may have been made to your revised submission. Prior to publication, the manuscript will be sent to you for final approval and made available via Epub.

    Thank you for considering publication with JNPM.

    Sincerely,

    Hany Aly, MD
    Editor-in-Chief
    Journal of Neonatal-Perinatal Medicine | Editorial Office
    900 23rd Street, NW, Suite G-2092
    Washington, DC 20037
    Tel: +1 202-715-5236

    ( 6/2015 )

    Abstract

    Objective: 

    The objective of this study was to identify predictors of mortality in infants with omphalocele.

    Methods: 

    Medical records of infants with omphalocele born between January 1992 and June 2012, with follow-up to December 2012, were retrospectively reviewed. Survivors and non-survivors were compared.  Evidence for pulmonary hypertension was sought between the second and seventh day after birth. Logistic regression was used to evaluate the importance and independence of various factors.

    Results:

    Of 51 infants whose records were reviewed, 13 died (25%) and 38 survived (75%).  The median time to death was 34 days (range:  4 - 408 days). The median follow-up time for those who died was 1.5 years (range:  0.01-15 years) and for survivors was 2.6 years (range:  0.08–15 years).  Logistic regression revealed that respiratory insufficiency at birth (OR:  14.8 (95%CI: 2.5-85.0)) and pulmonary hypertension (OR:  6.4 (95%CI:  1.1-39.0)) were independently associated with mortality.

    Conclusion:

    Respiratory insufficiency after birth and pulmonary hypertension are independent predictors of  mortality in infants with omphalocele.

    Key words:  pulmonary hypertension, omphalocele, infant, respiratory insufficiency, ventilator

               

     

  Abstract
  • Conference Paper: Comorbidities Delay Initial Feeding in Neonates with Omphalocele

    Janessa Law, Shelly H. Given, Shawn D St Peter, Donna A. Goff, Donna Thorpe, Andrew Hopper, Joanne E. Baerg  2014 American Academy of Pediatrics National Conference and Exhibition; 10/2014

    ( 11/2014 )
    Published abstract
  • Conference Paper: Delayed Enteral Feeding in Infants with Giant Omphalocele

    Shelly H. Given, Janessa Law, Shawn D. St. Peter, Donna A. Goff, Donna Thorpe, Andrew Hopper, Joanne E. Baerg

    2014 American Academy of Pediatrics National Conference and Exhibition; 10/2014

    ( 10/2014 )
    published 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