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Effect of neonatal circumcision on pain response during subsequent routine vaccination
A Taddio1, J Katz, A L Ilersich
1Department of Paediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Neonatal circumcision increases infant pain responses to later vaccinations. Pre-treating circumcision pain with Emla cream (lidocaine-prilocaine) reduced this heightened pain response in infants during vaccination.
Area of Science:
- Pediatric Pain Management
- Neonatal Care
- Infant Behavior
Background:
- Neonatal pain may have lasting effects on infant behavior.
- Neonatal circumcision is a common procedure with potential pain implications.
- Understanding long-term pain responses is crucial for infant well-being.
Purpose of the Study:
- To determine if neonatal circumcision alters pain response at 4- and 6-month vaccinations.
- To assess if Emla cream pretreatment for circumcision pain affects subsequent vaccination pain response.
- To compare pain responses between circumcised and uncircumcised infants.
Main Methods:
- Prospective cohort study of 87 infants in three groups: uncircumcised, circumcised with Emla, and circumcised with placebo.
- Infants were videotaped during vaccination at a primary care physician's clinic.
- Videotapes were scored by a trained research assistant for facial action, cry duration, and visual analogue scale pain scores, blinded to group status.
Main Results:
- Circumcised infants exhibited significantly higher pain responses (facial action, cry duration, VAS scores) during vaccination compared to uncircumcised infants.
- A linear trend showed increasing pain scores from uncircumcised infants to those circumcised with Emla, and highest scores in those circumcised with placebo.
- No significant differences in birth or infant characteristics were observed among the groups.
Conclusions:
- Neonatal circumcision is associated with an increased pain response to subsequent vaccinations.
- Preoperative Emla cream significantly attenuated the pain response to vaccination in circumcised infants.
- Recommendations include pain management during neonatal circumcision to mitigate long-term effects.
Background:
Preliminary studies suggested that pain experienced by infants in the neonatal period may have long-lasting effects on future infant behaviour. The objectives of this study were to find out whether neonatal circumcision altered pain response at 4-month or 6-month vaccination compared with the response in uncircumcised infants, and whether pretreatment of circumcision pain with lidocaine-prilocaine cream (Emla) affects the subsequent vaccination response.
Methods:
We used a prospective cohort design to study 87 infants. The infants formed three groups--uncircumcised infants, and infants who had been randomly assigned Emla or placebo in a previous clinical trial to assess the efficacy of Emla cream as pretreatment for pain in neonatal circumcision. Infants were videotaped during vaccination done at the primary care physician's clinic. Videotapes were scored without knowledge of circumcision or treatment status by a research assistant who had been trained to measure infant facial action, cry duration, and visual analogue scale pain scores.
Findings:
Birth characteristics and infant characteristics at the time of vaccination, including age and temperament scores, did not differ significantly among groups. Multivariate ANOVA revealed a significant group effect (p < 0.001) in difference (vaccination minus baseline) values for percentage facial action, percentage cry time, and visual analogue scale pain scores. Univariate ANOVAs were significant for all outcome measures (p < 0.05): infants circumcised with placebo had higher difference scores than uncircumcised infants for percentage facial action (136.9 vs 77.5%), percentage cry duration (53.8 vs 24.7%), and visual analogue scale pain scores (5.1 vs 3.1 cm). There was a significant linear trend on all outcome measures, showing increasing pain scores from uncircumcised infants, to those circumcised with Emla, to those circumcised with placebo.
Interpretation:
Circumcised infants showed a stronger pain response to subsequent routine vaccination than uncircumcised infants. Among the circumcised group, preoperative treatment with Emla attenuated the pain response to vaccination. We recommend treatment to prevent neonatal circumcision pain.