LYCOS RETRIEVER 
Circumcision: Neonatal Circumcision
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The AAP Task Force on Circumcision recommends the use of environmental, nonpharmacologic, and pharmacologic interventions to reduce pain and distress during neonatal circumcision. These interventions include the use of a sucrose pacifier, local application of a eutectic mixture of local anesthetic agents (prilocaine and lidocaine) (EMLA) cream, dorsal penile blocks, and ring blocks.
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The evidence indicates that neonatal circumcision prevents UTIs in the first year of life with an absolute risk reduction of about 1% and prevents the development of penile cancer with an absolute risk reduction of less than 0.2%. The evidence suggests that circumcision reduces the rate of acquiring an STD, but careful sexual practices and hygiene may be as effective. Circumcision appears to decrease the transmission of HIV in underdeveloped areas where the virus is highly prevalent. No study has systematically evaluated the utility of routine neonatal circumcision for preventing all medically-indicated circumcisions in later life. Evidence regarding the association between cervical cancer and a woman’s partner being circumcised or uncircumcised, and evidence regarding the effect of circumcision on sexual functioning is inconclusive. If the decision is made to circumcise, anesthesia should be used.
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In light of data like this, the Academy of Pediatrics revised its earlier anti-circumcision stand. In 1988 the AAP declared that "newborn circumcision has potential benefits and advantages as well as disadvantages and risks. In their 1999 statement, the AAP again stated, “Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; ... these data are not sufficient to recommend routine neonatal circumcision." A group of urologists from University of California at San Diego, (Niku, SD et al, Neonatal Circumcision, Urologic Clinics of North America, 22(1):57-65, February 1995), having thoroughly reviewed the evidence concluded, "Circumcision is usually a safe and simple operation when performed by an experienced operator. Its disadvantages are short-term, and its advantages are long-term. The medical benefits of circumcision appear to exceed the risks of the procedure."
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Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; ... these data are not sufficient to recommend routine neonatal circumcision. In the case of circumcision, in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. It is legitimate for parents to take into account cultural, religious, and ethnic traditions, in addition to the medical factors, when making this decision. Analgesia is safe and effective in reducing the procedural pain associated with circumcision; therefore, if a decision for circumcision is made, procedural analgesia should be provided. If circumcision is performed in the newborn period, it should only be done on infants who are stable and healthy.
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Neonatal circumcision has an estimated complication rate ranging from 0.1% to 35%. The vast majority of complications are infection, bleeding, and failure to remove enough foreskin. (5) One study of more than 350,000 newborns identified a complication rate of 1/476 (3) and another study estimated a complication rate of 1/100. (4) Meatitis and meatal stenosis are more serious complications that have been reported to occur in 8% to 21% of circumcised infants, (6) ... no well-controlled cohort study has clearly identified a causal relationship between circumcision and meatitis. (7) Although meatitis is believed to occur more frequently in circumcised infants, balanoposthitis is believed to occur more frequently in uncircumcised children. (8) Serious complications, such as necrotizing fascitis, urethral fistula, partial penile amputation, penile necrosis, and concealed penis, have been reported.
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According to data from the National Hospital discharge Survey, 1.2 million (65.3%) babies were circumcised in the United States in 1999, making this the highest rate of routine neonatal circumcision among developed nations. Healthcare coverage has and will continue to affect the rates of routine neonatal circumcision. As of 2004, 13 states had terminated Medicaid funding for neonatal circumcisions. At present, approximately 70% of obstetricians, 60% of family practitioners, and 35% of pediatricians practice newborn circumcision.
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Neonatal Circumcision