Objective
To report the characteristics, treatment, and short-term outcome of neonatal post-circumcision
bleeding, and to identify predictors of surgical treatment.
Materials and Methods
The medical records of 90 consecutive neonates who presented to the emergency room
with post-circumcision bleeding between 2009 and 2014 were reviewed. Circumcisions
were performed using the traditional Mogen shield device. The study end point was
surgical intervention for hemostasis. Predictors of surgical treatment were evaluated.
Results
An estimated total of 28,383 circumcisions were performed during the study period;
thus, the post-circumcision bleeding rate was 0.32%. Initial treatment included compressive
dressing in 15 infants (17%) and hemostatic dressing in 47 infants (52%); 28 infants
(31%) did not require treatment upon arrival to the emergency room. Two infants (2%)
received blood transfusion. Surgical treatment was required in 11 infants (12%); 10
of 43 infants (23%) with active bleeding on arrival to the emergency room required
surgery compared to 1 of 47 infants (2%) without active bleeding (P = .003). Similarly, 3 of 7 infants (43%) referred from other hospitals required surgery
compared to 8 of 83 infants (10%) referred from the community (P = .037). Abnormal blood tests at presentation were not associated with surgical treatment.
At 1 month of follow-up, 2 infants were admitted for recurrent bleeding. Coagulation
abnormalities were found in 4 infants.
Conclusion
Surgical treatment was required in 12% of infants presenting to the emergency room
with post-circumcision bleeding. The rate of surgical intervention was significantly
higher in infants with active bleeding at presentation and in those referred from
other hospitals. Physicians should consider admitting infants presenting with active
post-circumcision bleeding, whereas infants without active bleeding may be observed
and discharged.
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Article info
Publication history
Published online: April 04, 2017
Accepted:
March 28,
2017
Received:
January 22,
2017
Footnotes
Financial Disclosure: The authors declare that they have no relevant financial interests.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
