title: Post-ritual Circumcision Bleeding-Characteristics and Treatment Outcome.
abstract: OBJECTIVE
  To report the characteristics, treatment, and short-term outcome of neonatal post-circumcision bleeding, and to identify predictors of surgical treatment.
  
  
  METHODS
  The medical records of 90 consecutive neonates who presented to the emergency room with post-circumcision bleeding between 2009 and 2014 were reviewed. Circumcisions were performed using the traditional Mogen shield device. The study end point was surgical intervention for hemostasis. Predictors of surgical treatment were evaluated.
  
  
  RESULTS
  An estimated total of 28,383 circumcisions were performed during the study period; thus, the post-circumcision bleeding rate was 0.32%. Initial treatment included compressive dressing in 15 infants (17%) and hemostatic dressing in 47 infants (52%); 28 infants (31%) did not require treatment upon arrival to the emergency room. Two infants (2%) received blood transfusion. Surgical treatment was required in 11 infants (12%); 10 of 43 infants (23%) with active bleeding on arrival to the emergency room required surgery compared to 1 of 47 infants (2%) without active bleeding (P = .003). Similarly, 3 of 7 infants (43%) referred from other hospitals required surgery compared to 8 of 83 infants (10%) referred from the community (P = .037). Abnormal blood tests at presentation were not associated with surgical treatment. At 1 month of follow-up, 2 infants were admitted for recurrent bleeding. Coagulation abnormalities were found in 4 infants.
  
  
  CONCLUSIONS
  Surgical treatment was required in 12% of infants presenting to the emergency room with post-circumcision bleeding. The rate of surgical intervention was significantly higher in infants with active bleeding at presentation and in those referred from other hospitals. Physicians should consider admitting infants presenting with active post-circumcision bleeding, whereas infants without active bleeding may be observed and discharged.
authors.affiliation: Unit of Pediatric Urology, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address: roymano78@gmail.com.
authors.forename: Roy
authors.initials: R
authors.lastname: Mano
authors.affiliation: Unit of Pediatric Urology, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Amihay
authors.initials: A
authors.lastname: Nevo
authors.affiliation: Unit of Pediatric Urology, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Bezalel
authors.initials: B
authors.lastname: Sivan
authors.affiliation: Unit of Pediatric Urology, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Roy
authors.initials: R
authors.lastname: Morag
authors.affiliation: Unit of Pediatric Urology, Schneider Children's Medical Center, Petach Tikva, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: David
authors.initials: D
authors.lastname: Ben-Meir
mesh_terms: D002562:Ceremonial Behavior; D002944:Circumcision, Male / Q000009:adverse effects*; D004636:Emergency Service, Hospital; D006489:Hemostatic Techniques; D006801:Humans; D007231:Infant, Newborn; D007557:Israel; D008297:Male; D019106:Postoperative Hemorrhage / Q000209:etiology* / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome