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Effect of neonatal circumcision on pain responses during vaccination in boys
1Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada.
Insights
Neonatal circumcision in male infants may be linked to increased pain responses during routine vaccinations at 4 or 6 months. This study found circumcised boys exhibited higher pain scores and longer crying times during diphtheria-pertussis-tetanus (DPT) and Haemophilus influenzae type b conjugate (HIB) immunizations.
Area of Science:
- Pediatric Pain Management
- Neonatal Procedures
- Immunization Response
Background:
- Neonatal circumcision is a common procedure with potential long-term effects.
- The impact of neonatal circumcision on infant pain perception later in life is not fully understood.
Purpose of the Study:
- To investigate if male neonatal circumcision is associated with a heightened pain response to routine vaccinations at 4 or 6 months of age.
Main Methods:
- A post-hoc analysis of data from a randomized trial was conducted.
- Pain responses to diphtheria-pertussis-tetanus (DPT) and Haemophilus influenzae type b conjugate (HIB) vaccinations were blindly scored.
- Visual analogue and behavioral pain scores, along with crying duration, were assessed.
Main Results:
- Circumcised infants showed significantly higher observer-assessed pain scores after DPT vaccination (median 40 vs 26 mm, p = 0.03).
- Following HIB vaccination, circumcised infants exhibited higher behavioral pain scores (8 vs 6, p = 0.01) and longer crying durations (53 vs 19 s, p = 0.02).
Conclusions:
- Neonatal circumcision may influence pain perception and response to vaccination several months post-procedure.
- These findings suggest a potential link between early circumcision and altered pain sensitivity in infants.
Abstract:
Using data from one of our randomised trials, we investigated post-hoc whether male neonatal circumcision is associated with a greater pain response to routine vaccination at 4 or 6 months. Pain response during routine vaccination with diphtheria-pertussis-tetanus (DPT) alone or DPT followed by Haemophilus influenzae type b conjugate (HIB) was scored blind. 42 boys received DPT and 18 also received HIB. After DPT, median visual analogue scores by an observer were higher in the circumcised group (40 vs 26 mm, p = 0.03). After HIB, circumcised infants had higher behavioural pain scores (8 vs 6, p = 0.01) and cried longer (53 vs 19 s, p = 0.02). Thus neonatal circumcision may affect pain response several months after the event.