Notat om omskæring af drenge - Sundhedsstyrelsen

circumcision practices in theUnited States and elsewhere. The extent and level of training of theworkforce to sustain the availabilityof safe circumcision practices fornewborn males and their families.CONCLUSIONSThis technical report provides recommendationsregarding the practiceof male circumcision, particularly inthe newborn period. It emphasizes theprimacy of parental decision-makingand the imperative for those whoperform male circumcisions to beadequately trained and use both effectivesterile techniques and painmanagement. The report evaluatedcurrent evidence regarding the effectof male circumcision on the preventionof STIs (including HIV), UTIs, cancer, andother morbidities. Evidence about complicationsresulting from male circumcisionand the use of analgesiaand anesthesia were also discussed.The Task Force concluded that thehealth benefits of newborn male circumcisionoutweigh the risks andjustify access to this procedure forfamilies who choose it.The Task Force also made the followingrecommendations: 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 factually correct,nonbiased information aboutcircumcision that should be providedbefore conception and earlyin pregnancy, when parents aremost likely to be weighing the optionof circumcision of a male child. Physicians counseling families aboutelective male circumcision shouldassist parents by explaining, ina nonbiased manner, the potentialbenefits and risks, and by ensuringthat they understand the electivenature 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 penisat the time of discharge from thenewborn hospital stay, whether thenewborn is circumcised or not. Elective circumcision should beperformed only if the infant’s conditionis stable and healthy. Trained and competent practitioners,by using sterile techniquesand effective pain management,should perform male circumcision. Analgesia is safe and effective inreducing the procedural painassociated with newborn circumcision;thus, adequate analgesiashould be provided whenevernewborn circumcision is performed.8Nonpharmacologic techniques(such as positioning and sucrosepacifiers) alone are insufficientto prevent proceduraland postprocedural pain andare not recommended as thesole method of analgesia. Theyshould be used only as analgesicadjuncts to improve infantcomfort during circumcision.8 If used, topical creams maycause a higher incidence of skinirritation in low birth weight infants,compared with infants ofnormal weight, so penile nerveblock techniques should be chosenfor this group of newborns. Key professional organizations (AAP,AAFP, ACOG, the American Societyof Anesthesiologists, the AmericanCollege of Nurse Midwives, and othermidlevel clinicians such as nursepractitioners) should work collaborativelyto:8 Develop standards of traineeproficiency in performance ofanesthetic and procedure techniques,including suturing;8 Teach the procedure and analgesictechniques during postgraduatetraining programs;8 Develop educational materialsfor clinicians to enhance practitioners’competency in discussingthe benefits and risks ofcircumcision with parents;8 Offer educational materials to assistparents of male infants withthe care of both circumcised anduncircumcised penises. The preventive and public healthbenefits associated with newbornmale circumcision warrant thirdpartyreimbursement of the procedure.TASK FORCE ON CIRCUMCISIONSusan Blank, MD, MPH, ChairpersonMichael Brady, MD, Representing the Committeeon Pediatric AIDSEllen Buerk, MD, Representing the AAP Board ofDirectorsWaldemar Carlo, MD, Representing the AAPCommittee on Fetus and NewbornDouglas Diekema, MD, MPH, Representing theAAP Committee on BioethicsAndrew Freedman, MD, Representing the AAPSection on UrologyLynne Maxwell, MD, Representing the AAP Sectionon Anesthesiology and Pain MedicineSteven Wegner, MD, JD, Representing the AAPCommittee on Child Health FinancingLIAISONSCharles LeBaron, MD – Centers for DiseaseControl and PreventionLesley Atwood, MD – American Academy ofFamily PhysiciansSabrina Craigo, MD – American College ofObstetricians and GynecologistsCONSULTANTSSusan K. Flinn, MA – Medical WriterEsther C. Janowsky, MD, PhDSTAFFEdward P. Zimmerman, MSe778FROM THE AMERICAN ACADEMY OF PEDIATRICSDownloaded from pediatrics.aappublications.org by guest on June 19, 2013