The case against neonatal circumcision

SIR,—Many complications of circumcision, which include infection, haemorrhage, injuries to the glans and shaft, meatal ulcers, and meatal stenosis have been known for years. A recent leading article (5 May, p 1163) discussed current medical opinion on the subject. We would like to add the following case history to the literature.

A healthy 1-week-old infant had a circumcision performed by a well-trained and experienced physician without any anaesthetic. The infant tolerated the procedure well except for excessive crying, which began at the time of the operation. The mother, attempting to soothe the distressed infant, resumed breastfeeding after the operation. An episode of vomiting followed the feeding. An apnoeic spell followed the emesis. The infant was taken to a local emergency room and subsequently transferred to the Children's Hospital of Los Angeles. He received a complete septic workup, intravenous antibiotics and hospitalisation for five days of observation until the cultures were negative and sepsis was ruled out. The infant was discharged from the hospital six days after circumcision doing very well.

Infants do feel the pain of the surgical removal of the foreskin performed without any anaesthetic, and they respond to the pain by crying. That crying may be excessive. Air may be swallowed. Mothers do soothe their infants by feeding them. Vomiting may follow the feeding. Apnoea may follow vomiting.

Circumcision can be the onset of an unfortunate and unnecessary medical history. It is a procedure that should not be considered minor. If circumcision is done, it should be done with anaesthesia. But is it really worth the risk of anaesthesia? Pros and cons should be thoroughly and completely discussed with the infant's parents before the procedure is done.

PAUL M FLEISS
JOHN DOUGLASS

Los Angeles, California