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Published on: August 25, 2014
Newborn behavioral and physiological responses to circumcision
Margaret Malnory1, Teresa S Johnson, Russell S Kirby
1College of Nursing, University of Wisconsin at Milwaukee, Milwaukee, WI 53201, USA.
Insights
Preoperative acetaminophen may help manage newborn pain during circumcision. This study found reduced movement and improved breathing in infants receiving the medication, though crying increased slightly.
Area of Science:
- Neonatal care
- Pediatric pain management
- Surgical analgesia
Background:
- Circumcision is a common neonatal procedure often associated with pain.
- Current pain management strategies for neonatal circumcision vary, with some providers not routinely using analgesia.
- Assessing and managing procedural pain in newborns is crucial for their well-being.
Purpose of the Study:
- To evaluate the impact of preoperative acetaminophen on the behavioral responses of newborns undergoing circumcision.
- To determine if oral acetaminophen administered before circumcision can mitigate pain indicators.
Main Methods:
- A convenience sample of 53 male newborns (35-42 weeks GA) were divided into two groups: one receiving oral acetaminophen pre-procedure, the other receiving no analgesia.
- Behavioral responses were assessed using the Neonatal Inventory Pain Scale (NIPS) and physiological monitoring.
- Data collection occurred at multiple time points: preoperatively, intraoperatively, and up to 60 minutes postoperatively.
Main Results:
- Newborns receiving preoperative acetaminophen showed significantly lower NIPS scores for arm and leg movements, facial expression, state of arousal, and breathing quality.
- While crying scores were higher in the acetaminophen group, they remained in the lowest range for both groups.
- No demographic differences were observed between the groups.
Conclusions:
- Preoperative acetaminophen administration appears to be a beneficial intervention for managing pain associated with neonatal circumcision.
- This study supports the use of preoperative analgesia to improve newborn comfort during circumcision.
- Nurses should advocate for policy changes to ensure pain relief interventions are available for all newborns undergoing procedures.
Purpose:
To examine the effect of preoperative acetaminophen given as analgesia before circumcision on newborns' behavioral response.
Study Design And Methods:
A convenience sample of 53 male newborn infants (GA 35 to 42 weeks) who were.24 hours of age and whose parents had consented to circumcision were enrolled in the study. All of the infants enrolled were the patients of providers who did not routinely use anesthesia for circumcision. They were assigned to two groups based on physician standing order for preoperative acetaminophen. The first group received oral acetaminophen during the preoperative period; the second group received no preoperative analgesia. No further analgesia or anesthesia was given, as was the customary policy. Behavioral observations using the Neonatal Inventory Pain Scale (NIPS) and physiologic monitoring occurred at 5 minutes preoperatively, during application of restraints, at 1-minute intervals intraoperatively and at 5, 15, 30, and 60 minutes postoperatively.
Results:
There were no differences in the demographic variables between groups. The overall mean NIPS scores for the following characteristics were lower (indicating more relaxation) in newborns who received preoperative analgesia: arm movements (0.27 vs 0.52); leg movements (0.27 vs 0.59); facial expression (0.24 vs 0.27); state of arousal (0.15 vs 0.46); and breathing quality (0.20 vs 0.38). However, newborns who received pre-op analgesia had higher crying scores (0.42 vs 0.33), although both groups had mean crying scores in the lowest range.
Clinical Implications:
Despite its small sample size, this study suggests that preoperative analgesia before circumcision could be helpful in managing the pain of circumcision. Nurses have a responsibility to advocate for policy and practices changes that provide interventions for pain relief for all newborns.
