Weighing In on Newborn Circumcision

Discussion of Complications and Benefits With Health Care Provider Is Key to Decision-Making

By L.A. McKeown
WebMD Medical News

Jan. 10, 2000 (New York) -- Most parents are likely to be reassured by the results of a new study of more than 300,000 babies that shows complications from circumcision occur only in approximately one out of every 476 cases. The study, which appears in the January issue of the journal Pediatrics, indicates that while this common surgical procedure performed on baby boys just days after birth is relatively safe, worried parents should be aware that occasional problems such as bleeding and injury do occur.

"What's important to remember is that the vast majority of children will derive no benefit, nor will they suffer any harm as a result of [circumcision]," says lead author Dimitri A. Christakis, MD.

Circumcision is the surgical removal of the foreskin, which covers the head of the penis. Medically speaking, circumcision is thought to prevent urinary tract infections as well as cancer of the penis and sexually transmitted diseases later in life. However, the extent to which circumcision actually reduces any of these risks has been greatly debated, and some experts believe that as long as proper hygiene is maintained, the presence of the foreskin does not increase a man's risk of infections or cancer. Potential risks of circumcision have been less frequently examined, however.

"For most parents, the decision to circumcise their child is not based on the medical indications for it, but rather on the religious and cultural or other discretionary reasons," Christakis tells WebMD. "But for those parents who seek objective data, we wanted to be able to provide it for them." Christakis, who is a pediatrician at the University of Washington Child Health Institute in Seattle, says while many parents may view the complication rate as acceptably low, others may consider it to be intolerably high. In addition, some parents may simply be unaware that circumcision involves any risk of complications.

The Seattle researchers looked at the medical records of almost 135,000 male infants who underwent circumcision after birth, and nearly 224,000 who did not, to estimate the potential for complications as well as benefits. They found that 287 (0.22%) circumcised infants experienced complications such as bleeding or infection, complications that the authors attributed to the circumcision. None were considered serious, but they required additional medical attention and hospitalization.

The only infectious complication recorded was an infection of the skin and the tissue just beneath the skin, known as cellulitis, which occurred in two circumcised as well as two uncircumcised infants and was therefore not considered to be related to the procedure. Although there have been some reports of the "flesh-eating disease," necrotizing fascitiis, occurring in circumcised babies, the study did not find any cases of it.

According to a pediatrician on staff at Rush Presbyterian-St. Luke's Hospital in Chicago, the complications reported in the study are "extremely rare in good, reliable hands" and the complication rate "might be an overstatement." Bill Barrows, MD, who reviewed the study for WebMD, is also a mohel certified by the Berit Milah Board of Reform Judaism. He performs approximately 50 circumcisions every year. "In almost 20 years of experience, I have not seen one infection," he says.

Recently, the American Academy of Pediatrics released a policy statement on circumcision that concluded that the benefits are not significant enough to recommend newborn circumcision as a routine procedure. The AAP believes parents should be provided with accurate and unbiased information regarding both the risks and benefits of circumcision when making a decision regarding their baby.

So why perform circumcisions at all? Barrows says even if circumcision is not immediately medically beneficial for newborns due to illness or bleeding risk, the long-term medical benefits of the procedure do support its use in most cases. "Most medical people agree that circumcision is worthwhile. ... When you go back to the original data, the risk of cancer [and infection] ... is clearly lower in circumcised men," he says. "[The] long-term benefits are more clear," he adds. "We do a lot of things for our children. Childhood vaccinations is an example; fluoride in water is another. So is circumcision."

Barrows advises parents and their health care providers to discuss prior to the delivery whether to perform a circumcision on a male infant. This discussion should involve conversation about reducing pain to the newborn, aftercare, possible complications, benefits, and costs.



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