Notat om omskæring af drenge - Sundhedsstyrelsen

FROM THE AMERICAN ACADEMY OF PEDIATRICS Evaluation of current evidence indicatesthat the health benefits ofnewborn male circumcision outweighthe risks, and the benefitsof newborn male circumcision justifyaccess to this procedure forthose families who choose it. Parents are entitled to factuallycorrect, nonbiased information aboutcircumcision that should be providedbefore conception and early in pregnancy,when parents are most likelyto be weighing the option of circumcisionof a male child. Physicians counseling familiesabout elective male circumcisionshould assist parents by explaining,in a nonbiased manner, the potentialbenefits and risks and by ensuringthat they understand theelective nature of the procedure. Parents should weigh the healthbenefits and risks in light of theirown religious, cultural, and personalpreferences, as the medicalbenefits alone may not outweighthese other considerations for individualfamilies. Parents of newborn boys should beinstructed in the care of the penis,regardless of whether the newbornhas been circumcised or not. Elective circumcision should beperformed only if the infant’s conditionis stable and healthy. Male circumcision should be performedby trained and competentpractitioners, by using sterile techniquesand effective pain management. Analgesia is safe and effective inreducing the procedural pain associatedwith newborn circumcision;thus, adequate analgesia shouldbe provided whenever newborncircumcision is performed.8Nonpharmacologic techniques(eg, positioning, sucrose pacifiers)alone are insufficient toprevent procedural and postproceduralpain and are notrecommended as the sole methodof analgesia. They should beused only as analgesic adjunctsto improve infant comfort duringcircumcision.8 If used, topical creams may causea higher incidence of skin irritationin low birth weight infants,compared with infants of normalweight; penile nerve block techniquesshould therefore be chosenfor this group of newborns. Key professional organizations(AAP, the American Academy ofFamily Physicians, the AmericanCollege of Obstetricians and Gynecologists,the American Society ofAnesthesiologists, the AmericanCollege of Nurse Midwives, andother midlevel clinicians such asnurse practitioners) should workcollaboratively to:8 Develop standards of traineeproficiency in the performanceof anesthetic and proceduretechniques, including suturing;8 Teach the procedure and analgesictechniques during postgraduatetraining programs;8 Develop educational materialsfor clinicians to enhance theirowncompetencyindiscussingthe benefits and risks of circumcisionwith parents;8 Offer educational materials toassist parents of male infantswith the care of both circumcisedand uncircumcised penises. The preventive and public health benefitsassociated with newborn malecircumcision warrant third-partyreimbursement of the procedure.The American College of Obstetriciansand Gynecologists has endorsed thistechnical report. Pediatrics 2012;130:e756–e785INTRODUCTION AND BACKGROUNDStatement of the IssueThe American Academy of Pediatrics’(AAP) statement on circumcision ofthe newborn penis was last issued inMay 1999. 1 The Circumcision PolicyStatement recognized the health benefitsof circumcision but did not deemthe procedure to be a medical necessityfor the well-being of the child. Sincethat time, substantial contributionshave been made to the peer-reviewedliterature concerning circumcision ofmales and its possible benefits. For thisreason, in 2007, the AAP formed a TaskForce charged with reviewing currentevidence on male circumcision andupdating the policy on this procedureto provide guidance to AAP membershipregarding the circumcision ofnewborn males.The American College of Obstetriciansand Gynecologists has endorsed thistechnical report.BackgroundMale circumcision consists of thesurgical removal of some, or all, of theforeskin (or prepuce) from the penis. Itis one of the most common proceduresin the world. In the United States, theprocedure is most frequently performedduring the newborn period.Elective circumcision performed soonafter the newborn period is generallya result of deferral because of lowbirth weight or illness in the newborn.Circumcision after the newborn periodis most commonly performed becauseof the infant’s low birth weight or illnessprecluded newborn circumcision.Other infants are circumcisedlater in life because of the occurrenceof tight phimosis and/or urinary tractinfection (UTI).The 3 most common operative methodsof circumcision for the newbornmale include: the Gomco clamp, thePlastibell device, and the Mogen clamp(or variations derived from the samePEDIATRICS Volume 130, Number 3, September 2012Downloaded from pediatrics.aappublications.org by guest on June 19, 2013e757