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Neonatal Circumcision and Urinary Tract Infections in Infants With Hydronephrosis
Jonathan S Ellison1, Geolani W Dy2, Benjamin C Fu3
1Division of Pediatric Urology, Seattle Children's Hospital, Seattle, Washington; and jonathan.ellison@seattlechildrens.org.
Insights
Newborn circumcision significantly reduces urinary tract infection (UTI) risk in infant boys with hydronephrosis. This protective effect was observed across various urinary tract abnormalities, suggesting a broader benefit for this population.
Area of Science:
- Pediatric Urology
- Neonatal Health
- Infectious Disease Prevention
Background:
- Urinary tract abnormalities in boys may increase susceptibility to urinary tract infections (UTIs).
- The protective effect of newborn circumcision against UTIs in infants with hydronephrosis is not well-established.
- This study investigates the association between newborn circumcision and UTI rates in boys diagnosed with hydronephrosis.
Purpose of the Study:
- To determine if newborn circumcision reduces the risk of urinary tract infections (UTIs) in infant boys diagnosed with hydronephrosis.
- To compare UTI rates between circumcised and uncircumcised boys with hydronephrosis.
- To analyze the impact of circumcision on UTI risk across different types of hydronephrosis.
Main Methods:
- Utilized the MarketScan database to identify infant boys with hydronephrosis within the first 30 days of life.
- Compared the primary outcome of urinary tract infection (UTI) rates within the first year of life between circumcised and uncircumcised cohorts.
- Adjusted for potential confounding factors including region, insurance type, birth year, and infant comorbidities.
Main Results:
- Newborn circumcision was associated with a significantly decreased risk of UTI in boys with hydronephrosis (OR 0.36) and healthy controls (OR 0.32).
- The protective effect was consistent across specific diagnoses like isolated hydronephrosis, vesicoureteral reflux, and ureteropelvic junction obstruction.
- Preventing one UTI required circumcision in 10 boys with hydronephrosis, compared to 83 healthy boys.
Conclusions:
- Newborn circumcision is linked to substantially lower rates of urinary tract infections (UTIs) in infant boys diagnosed with hydronephrosis.
- The findings support a potential benefit of newborn circumcision for UTI prevention in this specific pediatric population.
- Circumcision demonstrates a protective effect against UTIs across various urinary tract abnormality etiological spectra.
Background:
Boys with urinary tract abnormalities may derive a greater benefit from newborn circumcision for prevention of urinary tract infection (UTI) than the general population. However, the effect of newborn circumcision on UTI is not well characterized across the etiological spectrum of hydronephrosis. We hypothesized that boys with an early diagnosis of hydronephrosis who undergo newborn circumcision will have reduced rates of UTI.
Methods:
The MarketScan data set, an employer-based claims database, was used to identify boys with hydronephrosis or hydronephrosis-related diagnoses within the first 30 days of life. The primary outcome was the rate of UTIs within the first year of life, comparing circumcised boys with uncircumcised boys and adjusting for region, insurance type, year of birth, and infant comorbidity.
Results:
A total of 5561 boys met inclusion criteria, including 2386 (42.9%) undergoing newborn circumcision and 3175 (57.1%) uncircumcised boys. On multivariate analysis, circumcision was associated with a decreased risk of UTI in both boys with hydronephrosis and healthy cohorts: odds ratio (OR) 0.36 (95% confidence interval [CI] 0.29-0.44) and OR 0.32 (95% CI 0.21-0.48), respectively. To prevent 1 UTI, 10 patients with hydronephrosis would have to undergo circumcision compared with 83 healthy boys. Among specific hydronephrosis diagnoses, circumcision was associated with a reduced risk of UTI for those with isolated hydronephrosis (OR 0.35 [95% CI 0.26-0.46]), vesicoureteral reflux (OR 0.35 [95% CI 0.23-0.54]), and ureteropelvic junction obstruction (OR 0.35 [95% CI 0.20-0.61]).
Conclusions:
Newborn circumcision is associated with a significantly lower rate of UTI among infant boys with hydronephrosis.
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