The Increasing Incidence of Newborn Circumcision: Data From the Nationwide Inpatient Sample

Nelson, Caleb P.; Dunn, Rodney L.; Wan, Julian; Wei, John T.

doi:10.1097/01.ju.0000145758.80937.7d

Cited by 89 publications

(53 citation statements)

References 15 publications

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“…246 The weighted rates of circumcision over the 13-year period from 1991 to 2005 were 40.8% for Medicaid clients versus 43.3% for the uninsured and 64.4% for insured newborns. 5 The associations with insurance status were independent of race/ethnicity and socioeconomic status in this study. 246 As noted, a recent cost-effectiveness analysis by the CDC concluded that newborn circumcision is a societal cost-saving HIV prevention intervention.…”

Section: Financing Newborn Male Circumcisionmentioning

confidence: 64%

“…4 The NIS indicates that circumcision was performed in 57% of male newborn hospitalizations between 1998 and 2005. NIS data from 1988 to 2008 indicate that the rate of circumcision performed during newborn male delivery hospitalizations increased significantly from 48% in 1988-1991, to 61% in 1997-2000, 5 then declined from 61% to 56% in 2000-2008 6 (Fig 1). Circumcision rates were highest in the Midwestern states (74%), followed by the Northeastern (67%) and Southern states (61%).…”

Section: Nismentioning

confidence: 99%

“…The findings of these studies are qualitatively similar and consistently estimate the rate of male circumcision to range from 42% to 80% among various populations. [2][3][4][5][6] A recent Centers for Disease Control and Prevention (CDC) study assessed trends in the incidence of in-hospital newborn male circumcision from 1999 to 2010 using 3 independent sources of discharge data on in-patient hospitalizations: the National Center for Health Statistics' National Hospital Discharge Survey (NHDS), the Agency for Healthcare Research and Quality' s National Inpatient Sample (NIS), and the SDI Health' s Charge Data Master (CDM). 2,3 These sources were used to estimate the incidence of newborn male circumcision in the first month of life.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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: Financing Newborn Male Circumcisionmentioning

confidence: 64%

Section: Nismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Male Circumcision

Blank¹,

Brady²,

Buerk³

et al. 2012

Pediatrics

297

149

View full text Add to dashboard Cite

show abstract

“…19 Yet, there appears to have been little decline in prevalence of neonatal circumcision in the USA as a result. An estimated 61% of male newborns were recorded as being circumcised on hospital discharge sheets in 2000, 20 and community surveys that include newborns circumcised for religious and other reasons outside the hospital setting have found higher neonatal male circumcision prevalence of 76-92%. 21 On the other hand, declines were seen both in Canada and Australia following similar statements by the medical authorities in those countries, and in the United Kingdom following the decision not to cover neonatal male circumcision on the National Health Service.…”

Section: Epidemiology and Acceptability Of Male Circumcisionmentioning

confidence: 99%

Male Circumcision: Implications for Women as Sexual Partners and Parents

Hankins¹

2007

Reproductive Health Matters

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“…Moreover, the newborn rate is increasing by 6.8% per year in the US. 85 In the UK, a rate of 6% is suggested. However, publications give: 7-10% for boys aged <15 years, 86 12.5% for ages 16-24 years, 15.9% for ages 25-34 and 26.4% for ages 35-44 (n = 1,874, 2,111 and 2,049, respectively), 87 and 48% in 305 London males aged 4-93 (av.…”

Section: Ratesmentioning

confidence: 99%

RACP's policy statement on infant male circumcision is ill‐conceived

Morris

Bailis²,

Castellsagué

et al. 2006

Australian and New Zealand Journal of Public Health

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Objective:To conduct a critical peer‐review of the 2004 Policy Statement on routine male circumcision produced by the Royal Australasian College of Physicians (RACP). Method:Comprehensive evaluation in the context of the research field. Results:We find that the current Statement downplays the wide‐ranging life‐long benefits of circumcision in prevention of urinary tract infections (UTIs), penile and cervical cancer, genital herpes and chlamydia in women, HIV infection, phimosis, and various penile dermatoses, and at the same time overstates the complication rate. We highlight the many errors in the RACP Statement and note that it sidesteps making a conclusion based on circumcision's well‐documented prophylactic health benefits by instead referring to the status of the foreskin at birth. In the era of preventative medicine we view this as irresponsible. Conclusion:The RACP's Statement on routine male circumcision is not evidence‐based and should be retracted. Implications:In the interests of public health and individual well‐being an extensive, comprehensive, evidence‐based revision should be conducted so as to provide scientifically accurate, balanced information on the advantages, and also the low rate of mostly minor complications, associated with this simple procedure, which for maximum benefits and minimal risk should ideally be performed in the neonatal period.

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The Increasing Incidence of Newborn Circumcision: Data From the Nationwide Inpatient Sample

Cited by 89 publications

References 15 publications

Male Circumcision

Male Circumcision

Male Circumcision: Implications for Women as Sexual Partners and Parents

RACP's policy statement on infant male circumcision is ill‐conceived

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