Is Neonatal Circumcision Judicious?

Machmouchi, M.; Alkhotani, Amal

doi:10.1055/s-2007-965417

Cited by 18 publications

(8 citation statements)

References 17 publications

(18 reference statements)

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“…201,202,[222][223][224][225][226][227][228] Comparison A study with fair evidence evaluated the use of the Gomco versus the Plastibell device in 350 newborn infants. 229 The incidence of infection was higher with the Gomco clamp (2%) versus a lower complication rate (1.3%) with the Plastibell device. Adhesions were also more common with the Gomco clamp, at a rate of 20% vs 6.6% for the Plastibell device.…”

Section: Mogen Clampmentioning

confidence: 88%

Male Circumcision

Blank¹,

Brady²,

Buerk³

et al. 2012

Pediatrics

297

149

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Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures in the world. In the United States, the procedure is commonly performed during the newborn period. In 2007, the American Academy of Pediatrics (AAP) convened a multidisciplinary workgroup of AAP members and other stakeholders to evaluate the evidence regarding male circumcision and update the AAP’s 1999 recommendations in this area. The Task Force included AAP representatives from specialty areas as well as members of the AAP Board of Directors and liaisons representing the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention. The Task Force members identified selected topics relevant to male circumcision and conducted a critical review of peer-reviewed literature by using the American Heart Association’s template for evidence evaluation. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks; furthermore, the benefits of newborn male circumcision justify access to this procedure for families who choose it. Specific benefits from male circumcision were identified for the prevention of urinary tract infections, acquisition of HIV, transmission of some sexually transmitted infections, and penile cancer. Male circumcision does not appear to adversely affect penile sexual function/sensitivity or sexual satisfaction. It is imperative that those providing circumcision are adequately trained and that both sterile techniques and effective pain management are used. Significant acute complications are rare. In general, untrained providers who perform circumcisions have more complications than well-trained providers who perform the procedure, regardless of whether the former are physicians, nurses, or traditional religious providers. Parents are entitled to factually correct, nonbiased information about circumcision and should receive this information from clinicians before conception or early in pregnancy, which is when parents typically make circumcision decisions. Parents should determine what is in the best interest of their child. Physicians who counsel families about this decision should provide assistance by explaining the potential benefits and risks and ensuring that parents understand that circumcision is an elective procedure. The Task Force strongly recommends the creation, revision, and enhancement of educational materials to assist parents of male infants with the care of circumcised and uncircumcised penises. The Task Force also strongly recommends the development of educational materials for providers to enhance practitioners’ competency in discussing circumcision’s benefits and risks with parents. The Task Force made the following recommendations:Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks, and the benefits of newborn male circumcision justify access to this procedure for those families who choose it.Parents are entitled to factually correct, nonbiased information about circumcision that should be provided before conception and early in pregnancy, when parents are most likely to be weighing the option of circumcision of a male child.Physicians counseling families about elective male circumcision should assist parents by explaining, in a nonbiased manner, the potential benefits and risks and by ensuring that they understand the elective nature of the procedure.Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.Parents of newborn boys should be instructed in the care of the penis, regardless of whether the newborn has been circumcised or not.Elective circumcision should be performed only if the infant’s condition is stable and healthy.Male circumcision should be performed by trained and competent practitioners, by using sterile techniques and effective pain management.Analgesia is safe and effective in reducing the procedural pain associated with newborn circumcision; thus, adequate analgesia should be provided whenever newborn circumcision is performed.Nonpharmacologic techniques (eg, positioning, sucrose pacifiers) alone are insufficient to prevent procedural and postprocedural pain and are not recommended as the sole method of analgesia. They should be used only as analgesic adjuncts to improve infant comfort during circumcision.If used, topical creams may cause a higher incidence of skin irritation in low birth weight infants, compared with infants of normal weight; penile nerve block techniques should therefore be chosen for this group of newborns.Key professional organizations (AAP, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, the American Society of Anesthesiologists, the American College of Nurse Midwives, and other midlevel clinicians such as nurse practitioners) should work collaboratively to:Develop standards of trainee proficiency in the performance of anesthetic and procedure techniques, including suturing;Teach the procedure and analgesic techniques during postgraduate training programs;Develop educational materials for clinicians to enhance their own competency in discussing the benefits and risks of circumcision with parents;Offer educational materials to assist parents of male infants with the care of both circumcised and uncircumcised penises.The preventive and public health benefits associated with newborn male circumcision warrant third-party reimbursement of the procedure. The American College of Obstetricians and Gynecologists has endorsed this technical report.

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Section: Mogen Clampmentioning

confidence: 88%

Male Circumcision

Blank¹,

Brady²,

Buerk³

et al. 2012

Pediatrics

297

149

View full text Add to dashboard Cite

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“…Machmouchi and Alkhotani compared the outcome of circumcisions conducted in early neonatal period and at 5 months age. Complications including meatal deformities, meatal stenosis, adhesions and infection were more frequent and more significant in the neonatal circumcision group (6). Van Howe found that neonatal circumcision increases the risk of penile inflammation particularly in boys younger than three years old (19).…”

Section: Discussionmentioning

confidence: 95%

“…Complication rates depend on various factors such as anatomic abnormalities, medical comorbidities, surgical techniques, and the age of circumcision (5). Numerous studies have been published concerning post-circumcision meatal stenosis in different ages with inconsistent results (2,(6)(7)(8). In addition, studies regarding the role of circumcision methods in meatal stenosis are scarce.…”

Section: Introductionmentioning

confidence: 99%

Meatal stenosis following circumcision with Plastibell device and conventional dissection Surgery; a prospective investigation

Ghods¹,

Soltany²,

Toussy³

et al. 2017

J Renal Inj Prev

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“…It has been reported in the literature that neonatal circumcision is less painful and is associated with fewer complications, but it requires more experience on the part of the surgeon. However, there are reports of increasing surgical complications associated with neonatal circumcision ( 19 - 21 ). The youngest child in our series was 1 month old, while the oldest patient was 14 years old; thus, no neonatal circumcision was performed.…”

Section: Discussionmentioning

confidence: 99%

At What Age Range Should Children Be Circumcised?

Biçer

Kuyrukluyıldız

Akyol

et al. 2015

Iran Red Crescent Med J

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Background:Although male circumcision is a surgical intervention that is frequently performed in children, there is no consensus about the age at which it should be performed.Objectives:The purpose of this study was to determine the best age range for routine male circumcision with respect to a child’s health and the cost.Patients and Methods:This clinical trial was conducted in the affiliated hospital of the Erzincan University of Medical Sciences, Turkey, in 2014. The circumcised children were evaluated in 3 groups: < 1 year old (Group 1), 1-7 years old (Group 2), and > 7 years old (Group 3). To obtain a satisfactory Wilton sedation score, midazolam 0.1 mg/kg IV was administered first. If adequate sedation was not achieved, ketamine 2 mg/kg IV was also administered. If adequate sedation was still not achieved, general anesthesia was administered via a laryngeal mask. At the end of the surgery, the groups were compared in terms of post-anesthesia recovery duration, complications, discharging duration, and cost.Results:A total of 603 children were circumcised, 374 in Group 1, 94 in Group 2, and 135 in Group 3. Midazolam was sufficient for sedation in 364 Group 1 patients (97.3%), 6 Group 2 patients (6.3%), and 38 Group 3 patients (28.1%). The shortest post-anesthesia recovery duration after surgical intervention and time until discharge, the lowest cost, and the fewest anesthesia complications were observed in Group 1 (P < 0.05 for all).Conclusions:Although almost all of the < 1 year-old children could be sedated with midazolam alone, most of the > 1 year-old children required ketamine or general anesthesia. Performing circumcision when children are less than 1 year old decreases the risk of complications due to anesthesia and lowers the costs compared with performing the procedure on older children.

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Is Neonatal Circumcision Judicious?

Abstract: From our study, circumcision at 5 months results in significantly fewer serious complications than circumcision in the neonatal period, irrespective of the method used. Therefore, neonatal circumcision should not be recommended.

Cited by 18 publications

References 17 publications

Male Circumcision

Male Circumcision

Meatal stenosis following circumcision with Plastibell device and conventional dissection Surgery; a prospective investigation

At What Age Range Should Children Be Circumcised?

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