Because postneonatal circumcision includes the risk of general anesthesia and costs more than elective neonatal circumcision, a retrospective study was performed to describe the population currently undergoing postneonatal circumcision and to identify the factors influencing decisions that lead to this procedure. A chart review and follow-up telephone survey were done to gather information concerning patients admitted for postneonatal circumcision to two Salt Lake City hospitals during a 2-year period. From the 135 patients eligible for analysis, two distinct groups emerged: the "sick" group (n = 52)—those who had neonatal complications, and the "well" group (n = 83)—those with no neonatal complications. The median age at circumcision was 5.5 months for the boys in the sick group and 35 months for the boys in the well group (P < .001, Student's t test). During the neonatal period, 32% of families in the well group received anticircumcision advice from their primary care physician. The decision in favor of circumcision was made by two thirds of the families of sick infants before their sons were 6 weeks of age. Other surgery was performed concurrent with the circumcision in 44% of patients in the sick group and 24% of patients in the well group (P < .0001, χ2). Balanitis, phimosis, or a physician's recommendation were listed as the primary reason for postneonatal circumcision by 50% of patents in the well group. Phimosis was listed by the surgeon as an indication for postneonatal circumcision in 65% of all patients's charts, although only 13% of parents listed phimosis as an indication for their children's circumcision. According to this profile of two distinct populations of postneonatal circumcision patients, pediatricians may be able to reduce the incidence of this procedure by providing support of individual preferences and objective information regarding circumcision to families of healthy infants during the neonatal period; by anticipating and facilitating the decisions surrounding neonatal circumcision for families of sick infants; and by educating families of uncircumcised boys about foreskin care and development during regular well-child visits.

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