Optimal time for neonatal circumcision: An observation-based study

Abstract 

Objective

A detailed observation-based study to determine the ideal age for neonatal circumcision.

Patients and methods

A prospective study of 583 neonatal circumcisions was carried out over a 3-year period (December 2005–December 2008). First a penile ring block was performed with 1% lignocaine solution, injected with a 26G needle. Formula milk, expressed breast milk or 20% sucrose solution was given to the child ad libitum as a further soothing agent. Circumcision was performed utilizing the Gomco sutureless clamp technique. Neonatal/Infant Pain Scale (NIPS) was used to score the severity of pain. NIPS ≥2 was taken to imply a painful procedure.

Results

Only 6.5% of neonates under 1week of age scored NIPS ≥2 during the procedure, but this reached 100% by the 4th week of life. There were 2 minor complications in this cohort.

Conclusion

Despite current controversy over whether it is ethical for parents to consent to a non-therapeutic neonatal circumcision, it remains a widely practiced procedure. Therefore it is important for pediatric surgeons/urologists to perform circumcision safely with minimal trauma to the neonate. This study shows that painless circumcision is possible in almost all newborns if it is performed during the first week after birth.

Keywords: Circumcision, Neonatal pain perception, Ring block, Neonatal surgery