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Neo-Natal (Infant) Circumcision
Benefits of Neo-Natal (Infant)Circumcision
Male circumcision can be performed at any age. Several factors should be considered when determining its timing.
One important advantage of infant male circumcision is that the procedure is simpler than that performed on older boys and men because the penis is less developed and the foreskin is thinner and less vascular. Healing is quicker and complication rates are lower. The period of superficial wound healing after infant male circumcision is generally 5-7 days and most wounds heal completely within 14 days. Performing circumcision in infancy provides several other advantages:
• the wound typically does not need to be sutured;
• the procedure is not complicated by erections, which can be problematic in adolescent boys and men;
• infant male circumcision ensures that the wound will be healed before sexual activity begins; sexual activity can complicate circumcision in adolescents and adult males and can put older patients who engage in such activity before the wound has healed at higher risk for HIV transmission.
Another advantage of early infant male circumcision is the reduced risk of urinary tract infections in the first 6 months of life. These infections typically present with signs and symptoms of systemic involvement and can be associated with significant complications, including sepsis and renal scarring. The benefit of male circumcision in preventing urinary tract infections in the first 6 months of life cannot be realized if the procedure is delayed until after infancy. This is especially pertinent if there is an underlying uropathy, such as vesicoureteral reflux or urinary tract obstruction.
Care of the Circumcised Infant
For the circumcised male, it takes about one week for the circumcision site to heal.
- Discuss with your physician and nurses the care your baby needs.
- Initially, the penis tip will be bright red. As healing occurs, the redness fades and the penis is a normal skin color from tip to base.
Right after the circumcision has been performed, it is normal for your baby to be sleepy and not too interested in eating, sometimes for one or two feedings. Don't worry - he'll soon realize he's missed a meal or two and make up for lost time. If you go home the day of the circumcision, make sure your baby has a wet diaper within eight hours of the procedure. Sometimes, giving the sleepy baby some water will accomplish this.
For the "gomco" circumcision, a small piece of gauze with petroleum jelly in the center is wrapped around the penis after circumcision. This should fall off after a few diaper changes. Do not reapply gauze, only apply a large amount of petroleum jelly for a few days to assist with healing and comfort. If gauze has not fallen off within 24-48 hours after circumcision, soak with warm water or a wash cloth and carefully remove and apply petroleum jelly for 2-4 more days. Do not forcibly remove gauze. This dressing helps prevent any irritation to the site and the diaper from sticking to the skin. The penis can be washed with warm water and should be kept clean of stool.>
For a "plastibell" circumcision, no dressings are required. The plastic ring will drop off five to eight days after circumcision. A dark brown or black ring of dead tissue encircling the plastic rim is normal and will fall off with the plastic ring. The result is a clean excision. Notify your doctor immediately if you notice any unusual swelling, active bleeding (usually appearing as a spot of blood larger than a quarter on the diaper) or foul odor, or if the plastic ring has not fallen off within eight days, or if the ring has slipped onto the shaft of the penis.
Normally, after circumcision the Vaseline gauze needs to be unwrapped and removed in an hour. The penis or diaper may be kept lightly lubricated with a little Vaseline or Neosporin ointment for the first day or two. No other special attention is necessary. Light bleeding leaving a spot in the diaper is fairly common in the first day or two. Also a yellow-white membrane may form in patches over the head of the penis and around the cut edge. After about ten days there should be no discharge or bleeding and the circumcision should look pretty well healed. The underside of the penis is usually the last to heal. If there is redness going down the shaft of the penis onto the abdomen or if there is a rash with blisters or the baby's behavior changes remarkably, let us know. You may give the baby 40 mgm of Acetominophen (up to the first line on the infant dropper) every four hours if the baby seems uncomfortable.
Links to further Information
Manual for early infant male circumcision under local anaesthesia, WHO
Very useful information about circumcision for infants, supplied by the World Health Organization.