Loma Linda University

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Joanne Baerg, MD
Associate Professor, Surgery
School of Medicine
Associate Professor, Pediatrics
School of Medicine
Research & Grantsmanship    Funded Research Project (CI)
  • Funded Study: Drs. S Ashwal, M. Gross, R Osterdock, K Tong, K Denmark, et al.  J. Baerg:  Consultant to NINDS grant. Pediatric Total Brain Injury and Diffuse Axonal Injury: Normal Appearing Brain is Not Normal. Grant period:  07-01-2006 - 06-30-2011    total funding:  $1,794,415 ( 7/2004 - 9/2014 )
     
  Non-Funded Research Project
  • “Virtual reality laparoscopic simulator: Comparison of Performance in Residents Participating in Simulation vs. No Simulation Training.”   IRB#5-11-0214  PI:  J Baerg, K Samakar, A Astudilllo, E Tagge, ME Reeves, C Garberoglio ( 4/2011 - 11/2014 )
    IRB approval for educational research studies relating to minimally invasive surgery.
  •  Thurman Merritt,  IRB #59100 "Systemic Hypotension following pediatric surgical procedure including patent ductus arteriosus ligation: the role of adrenal immaturity" Poster Presentation: Pediatric Academic Society, 2011 ( 9/2009 - 5/2011 )
     Sunwa Kim, R Peverini, M Goldstein, Joanne Baerg , D Deming,  AO Hopper
  •  Awareness of Abdominal Compartment Syndrome among Pediatric Health Care Providers      J. Chiaka Ejike, MD, FAAP1   Jennifer Newcombe, NP2    Joanne Baerg, MD3    Khaled Bahjri, MD, MPH4    Mudit Mathur, MD, FAAP1Ejike 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. ( 1/2008 - 9/2010 )
     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.  
  Abstracts Reporting Research -- Peer Reviewed
  • Investigation of Pediatric Spine & Spinal Cord Injury After Inflicted Trauma PRINCIPAL INVESTIGATOR:  Joanne Baerg BSc, MD (IRB #5100168) Others who will use, collect, or share PHI: Alexander Zouros MD, Amy Young MD, Timothy Young MD ( 1/2011 - 11/2014 )

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

     

  • Grant Applications     1) 2003-2008 J. Baerg: Consultant to NINDS grant. Pediatric Total Brain Injury and Diffuse Axonal Injury: Normal Appearing Brain is Not Normal. Ashwal, Holshauser, Freier, Tong, Gardner, Brandstater, Osterdock , Gross -Grant period:  07-01-2006 to 06-30-2011 total funding: $1,794,415 -Identification of Data Variables, generating data collection sheets and identification of control patients.     2) 2001-2003     Total Brain Injury-NIH Project Group     Ashwal, Baerg, Brandstater, Catalano, Collins, Colohan, Denmark, Freier, Holshauser,     Klanduch, Rogers, Shutter, Tong     Grant Preparation: Hypertonic Saline vs. Mannitol for Traumatic Brain Injury ( 3/2001 - 9/2014 )
  • Interdisciplinary Management with Emphasis on Surgery, Nutritional and Neuro-developmental Outcomes, and Quality of Life in Infants with Omphalocele (IRB #5100169) PRINCIPAL INVESTIGATOR:  Joanne Baerg BSc, MD ( 1/2011 - 11/2013 )
    Adam Woelk- Medical Student- supervision of Research Month

    Baerg JWoelk A ,  Longshore S ,  Thorpe  D   Incidence and Factors Associated with Non-Survival in Infants with Omphalocele.  (5 min)  So Cal Chapter of ACS. Santa Barbara 2013

     

  • A Multicenter Study Comparing Children with GERD Undergoing Single vs. Multiple Laparoscopic Fundoplications (IRB #5100277) PRINCIPAL INVESTIGATOR:  Joanne Baerg BSc, MD Others who will use, collect, or share PHI:  Shawn D. St. Peter MD (Children''''''''a Mercy Hospital, Kansas City, MO.), E Tagge MD, G Bultron MD ( Peds GI) ( 1/2011 - 11/2013 )
    Now published Manuscript in 2013- see below.
  • “A 20-year review of Congenital Diaphragmatic Morgagni Hernias”-PI J Baerg , IRB approved-IRB #  59115  Presented: 3 min poster presentation at the International Meeting of the Congenital Diaphragmatic Hernia Study Group.  Rome Italy, January 2011. ( 9/2009 - 1/2011 )
    co investigators- V. Kanthimathinathan*, D. Moores  * denotes resident  Published in Hernia in 2012- see below.
  • Baerg, Deming.  The Contribution of GERD to Weight Loss in NICU Infants.  Presented at American Pediatric Surgery Association  2010
      Published abstract; Pediatric Academic Society:    E-PAS20104424.543
    ( 5/2006 - 1/2011 )
    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, Shores, Fung, Yanni, Tagge, Deming Weight Gain in Infants With GERD Managed with Medical Therapy or Fundoplication. 3 minute Oral Poster presentation at the Canadian Association of Pediatric Surgeons. Toronto, Canada - August   2008. ( 8/2008 - 9/2010 )
    Published Abstract:  [2010] [236] The Role of Nissen Fundoplication in Promoting Weight Gain in Infants with GERD

    Joanne E. Baerg, Douglas Deming. Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA; Neonatology, Loma Linda University Children's Hospital, Loma Linda, CA.

    BACKGROUND: Weight gain in infants with GERD has not been well-studied.
    OBJECTIVE: To examine the role of Nissen fundoplication in promoting weight gain in infants with GERD.
    DESIGN/METHODS: An IRB approved retrospective review was performed between January 2004 and December 2006 of infants under 6 months who underwent a 24-hour pH probe for GERD evaluation. Growth curves were evaluated at the time of study, 6 months later and at follow-up (2-5 years). Infants who maintained or exceeded their growth curve were considered to gain. Data were analyzed by chi-square and logistic regression. P-values <0.05 were considered significant.
    RESULTS: 250 infants underwent a 24-hour pH-probe, 87(35%) had GERD. Thirty-one of 87(35.6%) underwent Nissen fundoplication and 56(64.4%) were treated with anti-reflux medications. Follow-up was complete for all 87. Nissen fundoplication was more likely to be carried out in infants with neurologic impairment (p=0.012), congenital heart disease (p=0.010), failure to thrive (p=0.015), inability to take food orally (p=0.001), vomiting(p=0.034), aspiration (p=0.030), and infants who were older than the mean age of the study group (0.027). Follow-up revealed similar proportions of infants with GERD who underwent Nissen fundoplication, 24/31 (77%) and infants treated with medications, 42/56 (75%), maintained their growth curves (p=0.801). Once infants were treated for GERD, logistic regression did not reveal a subgroup which gained better with either therapy: prematurity, OR 1.07 (95%CI 0.328-3.51), neurologic impairment OR .962 (95% CI 0.223-4.15), congenital heart disease, OR 1.49 (95% CI .257-8.64), inability to eat by mouth, OR 4.18 (95% CI .642-27.25), failure to thrive, OR .402(95% CI .089-1.806), vomiting, OR .927 (95% CI .219-3.92), and aspiration, OR 2.79 (95% CI .372-20.85). Recurrent GERD occurred in 5 Nissen patients (16%), but all maintained their growth curve and underwent re-do Nissen to control vomiting. Two of 56 treated with medications developed recurrent GERD (3.6%) at 7 and 11 months after pH probe and were losing weight. One underwent Nissen fundoplication and one underwent gastrojejunostomy placement.
    CONCLUSIONS: Infants with GERD are more likely to undergo Nissen fundoplication if they have neurologic impairment, congenital heart disease, failure to thrive, vomit, cannot take food orally, aspirate or are older at the time of pH probe. Once treated, they gain weight in equal proportion to those treated with medications.
    E-PAS2010236
  • Baerg J, Michelotti M, Tamez A Jose, Reeves M.  Laparoscopic Intracorporeal Suturing Among Residents:  Can We Predict Success?  J of Laparoscopic and Adv Surg Techniques, Volume 20, Suppl 1, 2010, S77.   ( 6/2009 - 6/2010 )
     
  • GERD in NICU Infants: Is a 24-hour pH Probe Study Always Necessary Prior to Gastrostomy Placement?   J Baerg MD, C  Tai MD, E Tagge MD, D Deming MD Loma Linda University Children’s Hospital So Cal Chapter of American College of Surgeons-Ped Surg Section Jan 2010

    Published Abstract:  [2010] [235] GERD in NICU Infants: Is a 24-Hour pH Probe Study Always Necessary Prior to Gastrostomy Placement?  Pediatric Academic Society ( 9/2009 - 1/2010 )
    Introduction: NICU infants who require a gastrostomy, are frequently evaluated for GERD by 24-hour pH probe, despite the absence of symptoms. Objectives: 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. 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.  Conclusion: 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.
  • Baerg, Ou Thoracoscopic and Laparoscopic Placement of a Pleuro-peritoneal Shunt In a Patient with Congenital Lymphedema and a Symptomatic Pleural Effusion 3 minute Oral Poster presentation at International Pediatric Endosurgery Group Meeting, Phoenix, AZ - April 2009. J of Laparoendoscopic and Advanced Surgical Techniques, volume 19: 2, p.292. ( 4/2009 - 9/2009 )
     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, Chiriano A Puzzling Case of Precocious Puberty in a Seven Year Old Girl  American College of Surgeons,  Jan 20, 2006.   Santa Barbara, CA ( 1/2006 - 7/2006 )
     
  • Chronic Intestinal Pseudo-obstruction in Children     Baerg, Elihu    Chronic Intestinal Pseudo-obstruction in Children  American College of Surgeons- Jan 19-21, 2007.  Santa Barbara, CA     Presented at Resident Research Day – May 2007.   ( 7/2004 - 7/2006 )
     
  •  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   ( 6/2004 )
     Presented at the American Academy of Pediatrics, October 2003.
  •  Gollin, Moores, Baerg            J Pediatr Surg. 2004 Jan;39(1):78-80. Getting Residents in the Game: An evaluation of General Surgery Residents  Participation in Pediatric Laparoscopic Surgery ( 1/2004 )
     
  •  Baerg,  Taylor    Pediatric Endosurgery & Innovative Techniques. December 1, 2003:445- 44   Laparoscopic Technique of Simultaneous Gastrostomy Tube Placement and Inguinal Hernia Repair in a Neonate ( 12/2003 )
     Also presented as Poster at International Pediatric Endosurgery Group, Los Angeles CA 2003
  •  Gollin, Abarbanell, Baerg J     J Pediatr Surg. 2003  Dec;38(12):1814-7.     Peritoneal drainage as definitive management of intestinal     perforation in extremely low-birth-weight infants. ( 12/2003 )
     
  •  Baerg, Kaban, Tonita, Pahwa, Reid     J Pediatr Surg. 2003  May;38(5):771-4.    Gastroschisis: A sixteen-year review.   ( 5/2003 )
     Presented as oral presentation at Canadian Association of Pediatric Surgeons, September 2002.
  •  Prince, Baerg Janner    Pediatr Infect Dis J. 2002 Oct;21(10):986, 990-1  Anterior Chest Wall Fistula in a Fourteen-Year-Old. ( 6/2002 - 10/2002 )
     
  •  Meyers, Baerg      J Pediatr Surg. 2001 May;36(5):726-9.   Farm accidents in children: Eleven Years of Experience. ( 3/2000 - 5/2001 )
     Presented at Canadian Association of Pediatric Surgeons, Sept. 2000.