Serious complications in male infant circumcisions in Scandinavia indicate that this always be performed as a hospital‐based procedure

Edler, Gertrud; Axelsson, Inge; Barker, Gillian; Lie, Susanne; Naumburg, Estelle

doi:10.1111/apa.13402

Cited by 25 publications

(31 citation statements)

References 12 publications

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“…Although not requiring general anesthesia, circumcision is an intensively painful procedure requiring adequate analgesia (60). Circumcision is associated with intraoperative and postoperative risks, including bleeding, shock, sepsis, circulatory shock, and hemorrhage (61–63) that can result in death (63, 64). …”

Section: Introductionmentioning

confidence: 99%

“…Lower complication rates for early and late adverse events have been attributed to underreporting with late adverse events mistakenly not attributed to circumcision (92, 93). Consequently, the low number ascribed to circumcision as the cause of death (63) may be underreported and erroneously attributed to other causes, such as sepsis (94) or SIDS.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, when bleeding an infant of low birth weight or GA, the effect may be pathological resulting in a reduced blood pressure that has been associated with obstructive sleep apnea (OSA), a condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing (108). It is, therefore, not surprising that most of the deaths following circumcision in high-income countries were due to bleeding (63). While it is accepted that failure of neural mechanisms causing arousal from sleep may play a role in at least some SIDS cases [e.g., Ref.…”

Section: Introductionmentioning

confidence: 99%

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A “Wear and Tear” Hypothesis to Explain Sudden Infant Death Syndrome

Elhaik

2016

Front. Neurol.

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Sudden infant death syndrome (SIDS) is the leading cause of death among USA infants under 1 year of age accounting for ~2,700 deaths per year. Although formally SIDS dates back at least 2,000 years and was even mentioned in the Hebrew Bible (Kings 3:19), its etiology remains unexplained prompting the CDC to initiate a sudden unexpected infant death case registry in 2010. Due to their total dependence, the ability of the infant to allostatically regulate stressors and stress responses shaped by genetic and environmental factors is severely constrained. We propose that SIDS is the result of cumulative painful, stressful, or traumatic exposures that begin in utero and tax neonatal regulatory systems incompatible with allostasis. We also identify several putative biochemical mechanisms involved in SIDS. We argue that the important characteristics of SIDS, namely male predominance (60:40), the significantly different SIDS rate among USA Hispanics (80% lower) compared to whites, 50% of cases occurring between 7.6 and 17.6 weeks after birth with only 10% after 24.7 weeks, and seasonal variation with most cases occurring during winter, are all associated with common environmental stressors, such as neonatal circumcision and seasonal illnesses. We predict that neonatal circumcision is associated with hypersensitivity to pain and decreased heart rate variability, which increase the risk for SIDS. We also predict that neonatal male circumcision will account for the SIDS gender bias and that groups that practice high male circumcision rates, such as USA whites, will have higher SIDS rates compared to groups with lower circumcision rates. SIDS rates will also be higher in USA states where Medicaid covers circumcision and lower among people that do not practice neonatal circumcision and/or cannot afford to pay for circumcision. We last predict that winter-born premature infants who are circumcised will be at higher risk of SIDS compared to infants who experienced fewer nociceptive exposures. All these predictions are testable experimentally using animal models or cohort studies in humans. Our hypothesis provides new insights into novel risk factors for SIDS that can reduce its risk by modifying current infant care practices to reduce nociceptive exposures.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A “Wear and Tear” Hypothesis to Explain Sudden Infant Death Syndrome

Elhaik

2016

Front. Neurol.

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“…Our finding that MNC is associated with SIDS is not surprising. Circumcision is associated with intra operative and postoperative risks, including bleeding, shock, sepsis, circulatory shock, hemorrhage, pain, and long-term consequences [12][13][14][73][74][75][76]]all of which contribute toward allostatic load [14,15] and thereby SIDS through various mechanisms [5]. For instance, circumcision reduces the heart rate [20] and together with the loss of blood there is a danger of reducing the blood volume, blood pressure, and the amount of oxygen reaching the tissues [5,77].…”

Section: Evaluating the Contribution Of Nmc Toward Sidsmentioning

confidence: 99%

“…Both stressor are male-biased [11] and may explain the male predominance of SIDS, whereas the first stressor may also explain the lower SIDS rates in Hispanics. MNC is associated with intraoperative and postoperative risks including bleeding, shock, sepsis, circulatory shock, and hemorrhage [12][13][14] that can result in death [14,15]. MNC may also cause severe and long-lasting pain, trauma, and psychological impairment due to the circumcision procedure that involves maternal separation, restraint to a board, and the removal of sensitive penile tissues that contain numerous nerve endings [16][17][18][19][20][21].…”

Section: Introductionmentioning

confidence: 99%

Adversarial childhood events are associated with Sudden Infant Death Syndrome (SIDS): an ecological study

Elhaik

2018

Preprint

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Sudden Infant Death Syndrome (SIDS) is the most common cause of postneonatal infant death. The allostatic load hypothesis posits that SIDS is the result of perinatal cumulative painful, stressful, or traumatic exposures that tax neonatal regulatory systems. To test it, we explored the relationships between SIDS and two common stressors, male neonatal circumcision (MNC) and prematurity, using latitudinal data from 15 countries and over 40 US states during the years 1999-2016. We used linear regression analyses and likelihood ratio tests to calculate the association between SIDS and the stressors. SIDS prevalence was significantly and positively correlated with MNC and prematurity rates. MNC explained 14.2% of the variability of SIDS's male bias in the US, reminiscent of the Jewish myth of Lilith, the killer of infant males. Combined, the stressors increased the likelihood of SIDS. Ecological analyses are useful to generate hypotheses but cannot provide strong evidence of causality. Biological plausibility is provided by a growing body of experimental and clinical evidence linking adversary preterm and early-life events with SIDS. Together with historical evidence, our findings emphasize the necessity of cohort studies that consider these environmental stressors with the aim of improving the identification of at-risk infants and reducing infant mortality.

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Systematic review of complications arising from male circumcision

2021

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Background: Neonatal male circumcision is the most common procedure performed on paediatric patients (Simpson et al., 2014) and one of the most common surgical procedures in the world (American Academy of Pediatrics, 2012).Methods: A search was conducted for articles about complications arising from male circumcision surgeries by entering the term 'male circumcision' into PubMed on June 16, 2020. Six thousand six hundred forty-one articles published from 1945 to 2020 were found. Seventy-eight articles were ultimately selected for the systematic review.Results: The 78 articles selected from the literature search were entered into one of three tables. The first table includes 15 articles pertaining to chart reviews and cohort studies and report complication rates. The second table reports specific complications from 51 case reports and case series, and the third table is a summary from 12 articles regarding physician questionnaires and society recommendations. Additionally, the 78 articles were used to compile a list of 47 specific complications arising from male circumcision surgeries.Conclusions: Complications from neonatal male circumcisions are common and healthcare providers need to be better informed of the potential complications of the surgery so that they can more effectively counsel their patients about potential risks, likelihood of complications and what can be done to prevent them. While experienced providers who practice in sterile settings have better outcomes with fewer complications, encouraging parents to take into account who is performing their son's circumcision, what was their training, how clean is their practice and how much experience they have and reminding them they have the option to decline the procedure entirely allow the parents to get a more complete picture and play an essential role in the decision-making process.

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Serious complications in male infant circumcisions in Scandinavia indicate that this always be performed as a hospital‐based procedure

Abstract: Complications following male circumcision in Scandinavia were relatively rare, but serious complications did occur. Based on the analyses of the severe cases, we argue that circumcision should only be performed at hospitals with 24-hour emergency departments.

Cited by 25 publications

References 12 publications

A “Wear and Tear” Hypothesis to Explain Sudden Infant Death Syndrome

A “Wear and Tear” Hypothesis to Explain Sudden Infant Death Syndrome

Adversarial childhood events are associated with Sudden Infant Death Syndrome (SIDS): an ecological study

Systematic review of complications arising from male circumcision

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