Factors Associated With Early Deaths Following Neonatal Male Circumcision in the United States, 2001 to 2010

Earp, Brian D.; Allareddy, Veerajalandhar; Allareddy, Veerasathpurush; Rotta, Alexandre T.

doi:10.1177/0009922818790060

Cited by 12 publications

(6 citation statements)

References 34 publications

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“…While acknowledging that complication rates from routine circumcision are low, critics argue that the chances of these complications being mutilatory, infective, or haemorrhagic are high and potentially catastrophic. Critics further argue that death, gangrene, and total or partial amputation are known adverse outcomes (Fox and Thomson 2005;Earp et al 2018;Elhaik 2019).…”

Section: Risks Of Male Circumcisionmentioning

confidence: 99%

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Should liberal government regulate male circumcision performed in the name of Jewish tradition?

Cohen‐Almagor

2020

SN Soc Sci

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The word "circumcision" comes from Latin circum (meaning "around") and cædere (meaning "to cut"). Cultural and religious justifications are employed to convince members of the community as well as outsiders that circumcision is reasonable and just. The purpose of the discussion is to suggest some cardinal changes to the practice of male circumcision in order to make it more humane and less painful to its subjects. Balancing between group rights and the rights of the child, it is essential to avoid unnecessary suffering. It is one of the liberal state’s obligations to protect the best interests of vulnerable third parties. The article opens with some preliminary data about male circumcision and then explains its importance in Judaism. It examines the medical reasons for male circumcision and the risks involved in the practice; subsequently, it discusses the critique of male circumcision. The article also highlights the points of agreement and disagreement between those supporting and opposing the ritual and insists that male circumcision should be performed by using anaesthesia. The final part of the article includes a proposal for humane male circumcision that considers religious sentiments and the rights of the child, aiming to strike a reasonable balance between competing interests. I hope the proposal will be debated in parliaments in the western world.

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Section: Risks Of Male Circumcisionmentioning

confidence: 99%

“…Deaths have also been reported. In the United States, deaths following circumcision in clinical settings occur at a rate of approximately 1 for every 50,000 circumcisions (Earp et al 2018;Shahvisi and Earp 2019). This figure is disputed.…”

Section: Critique Of the Practicementioning

confidence: 99%

Should liberal government regulate male circumcision performed in the name of Jewish tradition?

Cohen‐Almagor

2020

SN Soc Sci

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“…Infant MC‐related deaths are exceedingly rare, and occur mostly in nonmedical community circumcisions. Data from the US National Inpatient Sample found that during 2000‐2010, one death was recorded per 49 166 circumcisions during the first 30 days of life . The authors stressed that, “ this figure should not be interpreted as causal but correlational ” and “ may include both undercounting and overcounting .” Deaths were most common in neonates with significant comorbidities such as cardiac disease (OR 698), pulmonary circulatory disorders (OR 170), coagulopathy (OR 160), or fluid and electrolyte disorders (OR 68) (all P < .001).…”

Section: Physical Harmmentioning

confidence: 99%

Critical evaluation of arguments opposing male circumcision: A systematic review

Morris

Moreton²,

Krieger

2019

J Evidence Based Medicine

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Objective To systematically evaluate evidence against male circumcision (MC). Methods We searched PubMed, Google Scholar, EMBASE and Cochrane databases. Results Database searches retrieved 297 publications for inclusion. Bibliographies of these yielded 101 more. After evaluation we found: Claims that MC carries high risk were contradicted by low frequency of adverse events that were virtually all minor and easily treated with complete resolution. Claims that MC causes psychological harm were contradicted by studies finding no such harm. Claims that MC impairs sexual function and pleasure were contradicted by high‐quality studies finding no adverse effect. Claims disputing the medical benefits of MC were contradicted by a large body of high‐quality evidence indicating protection against a wide range of infections, dermatological conditions, and genital cancers in males and the female sexual partners of men. Risk‐benefit analyses reported that benefits exceed risks by 100‐200 to 1. To maximize benefits and minimize risks, the evidence supported early infant MC rather than arguments that the procedure should be delayed until males are old enough to decide for themselves. Claims that MC of minors is unethical were contradicted by balanced evaluations of ethical issues supporting the rights of children to be provided with low‐risk, high‐benefit interventions such as MC for better health. Expert evaluations of case‐law supported the legality of MC of minors. Other data demonstrated that early infant MC is cost‐saving to health systems. Conclusions Arguments opposing MC are supported mostly by low‐quality evidence and opinion, and are contradicted by strong scientific evidence.

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“…MNC involves maternal separation and restraint to a board with removal of highly sensitive penile tissues, which may increase the risk of long-term adverse psychosexual sequelae [29][30][31][32]. Research suggests that procedures that are far milder than MNC, such as routine heel punctures, can have persistent negative effects with changes to immune, endocrine, and behavioral reactions to stressful events continuing into childhood or even adulthood [33,34] Deaths following MNC have been known for a long time as also acknowledged in the Talmud [35] to present time [36] with most deaths associated with excessive bleeding, infection, and less frequently with anesthesia accidents and cardiac arrest (reviewed in [37]). Recently, Earp et al analyzed data from a US inpatient database of nearly 10 million MNCs over 10 years.…”

Section: Introductionmentioning

confidence: 99%

“…The authors attributed an early death rate of 2/100,000 to MNC. The risk of early death (first 30 days) increased for infants circumcised in a teaching hospital and if comorbid conditions (e.g., cardiac diseases) are present [36]. This death rate should be considered an underestimate, provided the lack of systematic collection of mortality statistics associated with non-therapeutic circumcision in the US, which precludes, for instance, tracking deaths occurring in a hospital other than the hospital where circumcision took place.…”

Section: Introductionmentioning

confidence: 99%

Neonatal circumcision and prematurity are associated with sudden infant death syndrome (SIDS)

Elhaik

2018

J Clin Transl Res

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Background: Sudden infant death syndrome (SIDS) is the most common cause of postneonatal unexplained infant death. The allostatic load hypothesis posits that SIDS is the result of cumulative perinatal painful, stressful, or traumatic exposures that tax neonatal regulatory systems. Aims: To test the predictions of the allostatic load hypothesis we explored the relationships between SIDS and two common phenotypes, male neonatal circumcision (MNC) and prematurity. Methods: We collated latitudinal data from 15 countries and 40 US states sampled during 2009 and 2013. We used linear regression analyses and likelihood ratio tests to calculate the association between SIDS and the phenotypes. Results: SIDS mortality rate was significantly and positively correlated with MNC. Globally (weighted): Increase of 0.06 (95% CI: 0.01-0.1, t = 2.86, p = 0.01) per 1000 SIDS mortality per 10% increase in circumcision rate. US (weighted): Increase of 0.1 (95% CI: 0.03-0.16, t = 2.81, p = 0.01) per 1000 unexplained mortality per 10% increase in circumcision rate. US states in which Medicaid covers MNC had significantly higher MNC rates (χ = 0.72 vs 0.49, p = 0.007) and male/female ratio of SIDS deaths (χ = 1.48 vs 1.125, p = 0.015) than other US states. Prematurity was also significantly and positively correlated with MNC. Globally: Increase of 0.5 (weighted: 95% CI: 0.02-0.086, t = 3.37, p = 0.004) per 1000 SIDS mortality per 10% increase in the prematurity rates. US: Increase of 1.9 (weighted: 95% CI: 0.06-0.32, t = 3.13, p = 0.004) per 1000 unexplained mortalities per 10% increase in the prematurity rates. Combined, the phenotypes increased the likelihood of SIDS. Conclusions: Epidemiological analyses are useful to generate hypotheses but cannot provide strong evidence of causality. Biological plausibility is provided by a growing body of experimental and clinical evidence linking aversive preterm and early-life SIDS events. Together with historical and anthropological evidence, our findings emphasize the necessity of cohort studies that consider these phenotypes with the aim of improving the identification of at-risk infants and reducing infant mortality. Relevance for patients: Preterm birth and neonatal circumcision are associated with a greater risk of SIDS, and efforts should be focused on reducing their rates.

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Factors Associated With Early Deaths Following Neonatal Male Circumcision in the United States, 2001 to 2010

Cited by 12 publications

References 34 publications

Should liberal government regulate male circumcision performed in the name of Jewish tradition?

Should liberal government regulate male circumcision performed in the name of Jewish tradition?

Critical evaluation of arguments opposing male circumcision: A systematic review

Neonatal circumcision and prematurity are associated with sudden infant death syndrome (SIDS)

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