Brian D Earp et al: Factors Associated with Early Deaths Following Neonatal Male Circumcision in the United States, 2001- 2010

Just published online (15 pages). The Conclusion (the numbers 48-51 are references):

In this study, using a validated multi-year national dataset, we identified 1 early death for every 49,166 newborn inpatient circumcisions, or 10.2 deaths per 500,000 newborn inpatient circumcisions; however, this figure cannot be simply interpreted as a causal relationship, since our study design allows for both undercounting and overcounting of deaths due to such circumcisions and we do not know the true proportion of over-counted versus under-counted deaths.

In addition, we identified a number of co-morbid conditions that were associated with a significant increase in the odds of death following newborn circumcision, and we have suggested that these may need to be considered as potential contra-indications for the surgery pending further research.

According to the AAP, repeated exposure to painful stimuli soon after birth can cause immediate and long- term adverse outcomes, including physiologic instability and altered brain development, as well as abnormal  somatosensory and stress response systems, which can persist into later childhood.48 The AAP therefore recommends that “every health care facility caring for neonates should implement a pain-prevention program that includes strategies for minimizing the number of painful procedures performed.”48 Since newborn circumcision is a surgical procedure that inevitably causes pain as well as carries other risks, up to and including death, and since it is performed on a healthy subject who does not require surgery on medical grounds, it is a clear candidate for a procedure whose incidence should be minimized, all things considered.

In this context, it should be remembered that the disvalue of any given risk is a function of its likelihood as well as its magnitude, which is in turn affected by which alternative courses of action are available.49 While the most common surgical risks associated with circumcision, such as pain, bleeding, or infection may be considered tolerable when a surgery is medically necessary, their disvalue to an individual is much greater when he is healthy and does not require surgery.50 In addition, while other risks associated with circumcision may be less common, they may also be extremely serious—as in the case of death—and must therefore be weighted more heavily in assessments of the value or disvalue of performing the surgery.51

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