Date: Wed, 18 Oct 1995 09:21:25 -0700
From: restore@PrimeNet.Com (D. Evans, Evans Industries)
Subject: Journal References
From: Dr. C. R. Barr
Subject: Journal References
Date: 18 Oct 95 11:10 EST
Taddio A. Goldbach M. Ipp M. Stevens B. Koren G.
Institution Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada.
Effect of neonatal circumcision on pain responses during vaccination in boys.
Lancet. 345(8945):291-2, 1995 Feb 4.
Using data from one of our randomised trials, we investigated post-hoc whether male neonatal circumcision is associated with a greater pain response to routine vaccination at 4 or 6 months. Pain response during routine vaccination with diphtheria-pertussis-tetanus (DPT) alone or DPT followed by Haemophilus influenzae type b conjugate (HIB) was scored blind. 42 boys received DPT and 18 also received HIB.
After DPT, median visual analogue scores by an observer were higher in the circumcised group (40 vs 26 mm, p = 0.03).
After hib, circumcised infants had higher behavioural pain scores (8 vs 6, p = 0.01) and cried longer (53 vs 19 s, p = 0.02). Thus neonatal circumcision may affect pain response several months after the event.
Howard CR. Howard FM. Weitzman ML.
Dept of Pediatrics, Rochester General Hospital, NY 14621.
Acetaminophen analgesia in neonatal circumcision: the effect on pain.
Pediatrics. 93(4):641-6, 1994 Apr.
OBJECTIVE. Recognizing the concerns about the use of local anesthesia in neonatal circumcision, a painful procedure usually performed without analgesia or anesthesia, we undertook a study of acetaminophen for pain management of this procedure. DESIGN. A prospective, randomized, double-blind, placebo-controlled, clinical trial of acetaminophen analgesia in 44 healthy full-term neonates undergoing circumcision was conducted. Beginning 2 hours before Gomco circumcision, neonates received either acetaminophen (15 mg/kg per dose, 0.15 mL/kg per dose) or placebo (0.15 mL/kg per dose) every 6 hours for 24 hours. Neonates were monitored intraoperatively for changes in heart rate, respiratory rate, and crying time.
Postoperative pain was assessed at 30, 60, 90, 120, 360 minutes, and 24 hours using a standardized postoperative comfort scoring system. Feeding behavior was also assessed before and after circumcision by nursing observation. RESULTS. Neonates in both groups showed significant increases in heart rate, respiratory rate, and crying during circumcision with no clinically significant differences observed between the groups. Postoperative comfort scores showed no significant differences between the groups until the 360-minute postoperative assessment, at which time the acetaminophen group had significantly improved scores (P < .05). Feeding behavior deteriorated in breast- and bottle-fed neonates in both groups, and acetaminophen did not seem to influence this
This study confirms that circumcision of the newborn causes severe and persistent pain. Acetaminophen was not found to ameliorate either the intraoperative or the immediate postoperative pain of circumcision, although it seems that it may provide some benefit after the immediate postoperative period.
Bergeson PS. Hopkin RJ. Bailey RB Jr. McGill LC. Piatt JP.
Department of General Pediatrics and Urology, Phoenix Children's Hospital, AZ.
The inconspicuous penis [see comments].
Pediatrics. 92(6):794-9, 1993 Dec.
OBJECTIVE: To describe the etiology and management of the group of abnormalities referred to as the inconspicuous penis.
DESIGN: Analysis of 19 cases seen over a period of 2 years by chart review.
SETTING: Children's hospital in a major metropolitan area.
PATIENTS: Nineteen boys referred to two pediatric urologists over a period of 2 years with penises
that appeared abnormally small, but on palpation and measurement, were found to have a normal shaft with a normal stretched length. Diagnoses included were buried penis, webbed penis, and trapped penis. Patients ages ranged from 1 week to 13 years.
FINDINGS: There were eight patients (42%) with trapped penis, and all were complications of circumcision (age 1 week to 7 months).
Cohen HA. Drucker MM., Vainer S., Ashkenasi A., Amir J., Frydman M., Varsano I.
Department of Pediatrics, Hasharon Hospital, Golda Medical Center, Petach Tikva, Israel.
Postcircumcision urinary tract infection.
Clinical Pediatrics. 31(6):322-4, 1992 Jun.
The possible association of urinary tract infection (UTI) with ritual circumcision on the eighth day of life was studied by analyzing the epidemiology of urinary tract infections during the first year of life in 169 children with UTI (56 males and 113 females) born in Israel from 1979 to 1984. Forty-eight percent of the episodes of UTI occurring in males appeared during the 12 days following circumcision, and the increased incidence during that period was highly significant. The median age of the males at the time of the UTI was 16 days, compared with seven months in females.
Circumcision as practiced in israel may be a
predisposing factor for uti during the 12-day period following that procedure.
Department of Pediatrics, Medical College of Ohio, Toledo 43699.
Circumcision: is the risk of urinary tract infection really the pivotal issue?.
Clinical Pediatrics. 31(2):100-4, 1992 Feb.
Recent information regarding the increased risk of urinary tract infections in the first year of life for uncircumcised boys has created confusion regarding the appropriate guidance to be given to parents confronting the circumcision issue.
A decision model was built that addressed the question of whether or not to circumcise a newborn male considering the probability of a non-circumcised boy having a UTI in the first year of life (0.041), the probability of a circumcised boy having a UTI in the first year of life (0.002), and the likelihood of renal
scarring from a UTI (0.075).
After considering the morbidity associated with the procedure, all possible outcomes were ranked from worst to best (circumcised-renal pathology to uncircumcised-no infection) and given a value on a 0 to 1 scale. For the set of values assigned to the outcomes, the choice of no circumcision yielded the highest expected utility.
For the set of assigned utilities, sensitivity analysis showed that unless the probability of a uti in the first year of life for an uncircumcised male was greater than or equal to 0.29, then non-circumcision was still the preferred choice. The decision was most sensitive to the degree of aversion to the morbidity associated with the procedure (pain, bleeding, inflammation).
--Courtesy "D." Evans, Evans Industries
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