Neonatal Facial Coding System Scores and Spectral Characteristics of Infant Crying During Newborn Circumcision

Lehr, Victoria Tutag; Zeskind, Philip Sanford; Ofenstein, John P.; Cepeda, Eugene; Warrier, Indulekha; Aranda, Jacob V.

doi:10.1097/ajp.0b013e31805476f2

Cited by 32 publications

(28 citation statements)

References 51 publications

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“…144 There is good evidence that DPNB is superior to lidocaine-prilocaine in relieving pain during and after circumcision in newborns. 142,[160][161][162] One good-quality prospective cohort study of 491 newborn circumcisions measured complications of DPNB analgesia; it reported an 11% incidence of bruising and a 0.2% incidence of hematoma, none of which required any change in management. 163 Another good-quality, blinded, randomized controlled trial found a 43% incidence of small hematomas in preterm and term newborns circumcised by using DPNB.…”

Section: Dpnbmentioning

confidence: 99%

Male Circumcision

Blank¹,

Brady²,

Buerk³

et al. 2012

Pediatrics

298

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: Dpnbmentioning

confidence: 99%

Male Circumcision

Blank¹,

Brady²,

Buerk³

et al. 2012

Pediatrics

298

149

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“…In the temporal domain, a curvilinear relationship may exist. Cries with either longer or shorter expiratory sounds, along with either longer or shorter pauses, both reflect the greatest infant arousal (Zeskind et al, 2006; Tutag-Lehr et al, 2007) and elicit the greatest adult arousal and perceived urgency (Zeskind et al, 1992). Adults’ responses to these changes in their arousal depend on the emotional characteristics and perceptual set of the caregiver.…”

Section: Crying Of Human Infants and Rat Pupsmentioning

confidence: 99%

“…Most studies have used their own idiosyncratic methods and measures of the cry sound. For example, whereas the CRI system differentiates between hyperphonated and phonated acoustic structures for reported measures of the fundamental frequency of the human infant cry (Lester et al, 2003), others report the Peak F 0 , independent of the acoustic structure, as a means of describing the highest pitched sound in the cry (Zeskind et al, 2005; Tutag-Lehr et al, 2007). In this case, the average F 0 determined from phonated cry sounds may be lower than the average F 0 of cry sounds that include both phonated and high-pitched hyperphonated cry segments.…”

Section: Challenges To a Translational Analysismentioning

confidence: 99%

“…For example, whereas in the human cry literature, Peak F 0 refers to where the fundamental frequency reaches its highest point (in hertz), analyses of rat pup USVs typically refer to the Peak F 0 as the frequency where the fundamental frequency has the highest power (amplitude). In this case, the Peak F 0 of a human infant cry might be described as the Maximum F 0 in a rat pup USV and the Peak F 0 in a rat pup USV might be described as the Dominant Frequency in the cry of the human infant (although not from an averaged power spectrum; Tutag-Lehr et al, 2007). Accurately measuring the Peak F 0 of the human infant cry at its highest amplitude is often precluded by the often-present case of dysphonation.…”

Section: Challenges To a Translational Analysismentioning

confidence: 99%

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Development of Translational Methods in Spectral Analysis of Human Infant Crying and Rat Pup Ultrasonic Vocalizations for Early Neurobehavioral Assessment

Zeskind¹,

McMurray²,

Garber³

et al. 2011

Front. Psychiatry

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The purpose of this article is to describe the development of translational methods by which spectrum analysis of human infant crying and rat pup ultrasonic vocalizations (USVs) can be used to assess potentially adverse effects of various prenatal conditions on early neurobehavioral development. The study of human infant crying has resulted in a rich set of measures that has long been used to assess early neurobehavioral insult due to non-optimal prenatal environments, even among seemingly healthy newborn and young infants. In another domain of study, the analysis of rat put USVs has been conducted via paradigms that allow for better experimental control over correlated prenatal conditions that may confound findings and conclusions regarding the effects of specific prenatal experiences. The development of translational methods by which cry vocalizations of both species can be analyzed may provide the opportunity for findings from the two approaches of inquiry to inform one another through their respective strengths. To this end, we present an enhanced taxonomy of a novel set of common measures of cry vocalizations of both human infants and rat pups based on a conceptual framework that emphasizes infant crying as a graded and dynamic acoustic signal. This set includes latency to vocalization onset, duration and repetition rate of expiratory components, duration of inter-vocalization-intervals and spectral features of the sound, including the frequency and amplitude of the fundamental and dominant frequencies. We also present a new set of classifications of rat pup USV waveforms that include qualitative shifts in fundamental frequency, similar to the presence of qualitative shifts in fundamental frequency that have previously been related to insults to neurobehavioral integrity in human infants. Challenges to the development of translational analyses, including the use of different terminologies, methods of recording, and spectral analyses are discussed, as well as descriptions of automated processes, software solutions, and pitfalls.

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“…Such clinical scoring systems are often multimodal and not only include scoring of the body movements, but also acoustic features of the cry signal [6][7][8][9]. Within a predefined context like pain, analysis of crying characteristics might therefore provide additional information [3,10].…”

Section: Introductionmentioning

confidence: 99%

Decoupling between fundamental frequency and energy envelope of neonate cries

Silva

Mijović

Bergh

et al. 2010

Early Human Development

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General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.-Users may download and print one copy of any publication from the public portal for the purpose of private study or research -You may not further distribute the material or use it for any profit-making activity or commercial gain -You may freely distribute the URL identifying the publication in the public portal Take down policyIf you believe that this document breaches copyright, please contact us providing details, and we will remove access to the work immediately and investigate your claim. Background: The presence of decoupling, i.e. the absence of coupling between fundamental frequency variation and energy envelope during phonetic crying, and its extent, reflects the degree of maturation of the central nervous system. Aim: We hereby wanted to assess the existence and extent of decoupling in term neonates (neurodevelopmental relevance) and whether an association between decoupling and clinical pain expression could be unveiled (clinical relevance). Study design: To assess decoupling in healthy term neonates during procedural pain, newborns were videotaped and crying was recorded during venous blood sampling. Besides acoustic analysis, pain expression was quantified based on the Modified Behavioral Pain Scale (MBPS). Subjects: 47 healthy term neonates underwent venous blood puncture at the 3rd day of life. Outcome measures: Beside the MBPS score, the correlation coefficients were calculated between the fundamental frequency variation and energy envelope of the cries. Results: Based on data collected in 47 healthy term neonates, correlation coefficients varied between 0.20 and 0.68. The degree of decoupling displayed extensive variability between the neonates and also in different cry bouts in a crying sequence within an individual neonate. A negative association was found between MBPS value and decoupling (r 2 = − 0.12), the same as for the intra-subject variability although less extensive (r 2 = − 0.02). Conclusion:Decoupling only relates weakly with the amount of distress in 3 day old newborns, even though a great intra-subject variability is present. This study suggests that there is no evidence of extensive decoupling as the newborn still has to fully develop the control of larynx and abdominal muscles.

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Neonatal Facial Coding System Scores and Spectral Characteristics of Infant Crying During Newborn Circumcision

Abstract: These data provide some of the first known evidence linking specific measures of infant crying with an independent, validated measure of pain.

Cited by 32 publications

References 51 publications

Male Circumcision

Male Circumcision

Development of Translational Methods in Spectral Analysis of Human Infant Crying and Rat Pup Ultrasonic Vocalizations for Early Neurobehavioral Assessment

Decoupling between fundamental frequency and energy envelope of neonate cries

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