Circumcision & Hypovolemic Shock

Menstuff® has compiled the following information on the increasing danger of hypovolemic shock from circumcision.

Increased Dangers of Neonatal Circumcision


The present medical policy in the United States and some other English-speaking nations is to offer and perform elective non-therapeutic circumcision of infant males to be performed at the request of the parents. New evidence of increased risks associated with that surgical procedure has emerged. This statement's purpose is to inform hospital administrators, doctors, and parents of those increased risks.

Hypovolemic Shock. The recent, highly publicized, death by hypovolemic shock of a healthy Canadian boy caused by hemorrhage from his circumcision wound has forced a reexamination of the risks occurred from bleeding.

The prepuce is highly vascularized, so it is likely to hemorrhage when cut, and severing the frenular artery is very common. Infants have a miniscule amount of blood in their tiny bodies and can tolerate only about a 20 percent blood loss before hypovolemia, hypovolemic shock, and death. A 4000 gram male newborn has only 11.5oz (340 ml) of total blood volume at birth, 85 ml per kilogram of weight. Blood loss of only 2.3oz, (68 ml) less than one-quarter of a cup, 20% of total blood volume at birth is sufficient to cause hypovolemia. The quantity of blood loss that might kill an infant (85ml) is easily concealed in today’s highly absorbent disposable diaper. Many newborns, and especially premature infants, weigh much less and a smaller amount of blood loss would be sufficient to trigger hypovolemic shock in those infants. Circumcision of infants, therefore, carries the inherent danger of hypovolemic shock and death.

Methicillin Resistant Staphyloccus Aureus. This month’s edition of Archives of Disease in Childhood (London) reports a substantial increase in bacteremia (viable bacteria circulating in the blood) caused by Methcillin Resistant Staphyloccus aureus (MRSA) in children. The article (Archives of Disease in Childhood 2004;89:378-379) identifies vancomycin as the treatment of choice against MRSA, but the authors caution that vancomycin resistant Staphyloccus aureus is now emerging. The authors report that "MRSA bacteremia is associated with a higher mortality rate, longer hospital stays and is a significant independent risk factor for death."

St. Catherine’s Hospital on Long Island experienced an outbreak of MRSA infection among circumcised boys in the newborn nursery in 2003; Arlington Hospital in Arlington, VA had a similar outbreak in 1995; and the naval hospital in North Carolina had an outbreak of non-resistant S. aureus in 1998.

The time may be coming when antibiotics may not be effective against some infections. This would return us to the situation that prevailed before the discovery of penicillin in the 1940s.

A reappraisal of the merit of non-therapeutic circumcision is underway. We hope the substance of this statement may serve to inform that decision.
Source: Contact Infor: Doctors Opposing Circumcision (D.O.C.), George Hill, 2442 NW Market St., Suite 42, Seattle, WA 98107, iconbuster@earthlink.net or faculty.washington.edu/gcd/DOC  

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