by Anne Eglash MD, IBCLC, FABM
Does the timing of a circumcision impact the success of early breastfeeding?
Getting off to a good start with exclusive breastfeeding in the hospital is associated with breastfeeding success as an outpatient. The question here is whether the timing of a circumcision has an effect on exclusive breastfeeding rates by hospital discharge, or in the first few weeks after discharge.
A group of researchers evaluated medical records of 797 healthy term boys who were born at a large naval hospital in San Diego California, and who were circumcised before hospital discharge. All mothers had an intention to breastfeed. They recorded the age at which the boys had circumcisions, and the rate of exclusive breastfeeding at hospital discharge, the first outpatient newborn exam, and the 2 week well child exam. Exclusive breastfeeding was defined as no formula given. Several factors were controlled for, such as maternal age, educational status, having a deployed spouse, parity, cesarean vs vaginal birth, race and infant health complications such as jaundice.
The authors did not compare breastfeeding rates between circumcised and non-circumcised boys. They were basically interested in seeing how the timing of circumcision influenced exclusive breastfeeding.
The authors found that the average age of circumcision was 29.7 hours, with 31% having been circumcised before 24 hours of age.
What do you think the authors found regarding the impact of age of circumcision on exclusive breastfeeding rates? Choose 1 or more:
- Newborns who had their circumcisions done after 24 hours were more likely to be exclusively breastfeeding at hospital discharge and at the newborn and 2 week exams.
- Infants born via vaginal delivery had higher exclusive breastfeeding rates at discharge as compared to infants born via cesarean delivery.
- Less than 50% of these circumcised newborns were exclusively breastfeeding at hospital discharge.
- All of the circumcised newborns had higher rates of exclusive breastfeeding at 2 weeks than at hospital discharge or at the newborn exam.
- There was no difference in exclusive breastfeeding rates based on age of circumcision.
See the Answer
The answer is B and E
Timing of Circumcision and Breastfeeding Initiation Among Newborn Boys
Lisa Mondzelewski, MD, MPH,a Sheila Gahagan, MD, MPH,b Christine Johnson, MD,a Hala Madanat, PhD,c,d Kyung Rhee, MD, MScb
ABSTRACT BACKGROUND AND OBJECTIVES:
Newborn circumcision, particularly in the first 24 hours of life, has been thought to adversely affect breastfeeding initiation. However, no studies specifically support an association between early circumcision and difficulty with breastfeeding initiation or maintenance. This study was designed to determine whether timing of newborn circumcision affects rates of exclusive breastfeeding during the first 2 weeks of life.
METHODS:
A retrospective study of 797 newborn boys and their mothers was conducted at a large military hospital. Exclusion criteria included gestational age ,38 weeks, multiple delivery, NICU admission, and absence of maternal intention to breastfeed. Multivariable logistic regression models examined the relationship between time of elective circumcision and exclusive breastfeeding at 3 time points: hospital discharge and the newborn and 2-week outpatient visits.
RESULTS:
Mean infant age at circumcision was 29.7 hours. Thirty-one percent were circumcised at ,24 hours of age. Rates of exclusive breastfeeding were 66.8%, 64.1%, and 63.7% at hospital discharge and the newborn and 2-week outpatient visits, respectively. In the multivariable model, time of circumcision was not significantly associated with exclusive breastfeeding at hospital discharge (odds ratio [OR], 1.01; 95% confidence interval [CI], 0.99–1.00; P 5 .54), the newborn outpatient visit (OR, 1.00; 95% CI, 0.99–1.02; P 5 .84), or the 2-week outpatient visit (OR, 0.99; 95% CI 0.98–1.01; P 5 .44).
CONCLUSIONS:
There was no significant association between timing of elective newborn circumcision and exclusive breastfeeding in the first 2 weeks of life. In this setting, early circumcision of otherwise healthy, term boys had no deleterious effects on breastfeeding initiation or maintenance.
Hospital Pediatrics 6(11) November 2016
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
The authors of this study point out that there has been very little research comparing exclusive breastfeeding rates at discharge between circumcised and non-circumcised male infants. That means we don’t know if circumcising impacts breastfeeding rates.
The sad thing about the circumcised infants in this population is that their exclusive breastfeeding rates were overall low, 66.8% at hospital discharge, 64.1% at the newborn exam, and 63.7% at the 2-week visit. According to the Center for Disease Control Breastfeeding Report Card, 82.9 % of infants nationwide in 2013 were exclusively breastfeeding at hospital discharge, and that rate was 85.6 % in California. So this makes me wonder whether the hospital was not particularly supportive of breastfeeding, or whether the circumcision itself was associated with increased formula supplementation before hospital discharge.
In conclusion, this study was large and well controlled, but it seems to leave more questions than answers about circumcision and breastfeeding!