Newborn Circumcision Associated With Lower UTI Rate in Infants With Hydronephrosis

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Circumcision was associated with decreased risk of UTI in boys with hydronephrosis.
Circumcision was associated with decreased risk of UTI in boys with hydronephrosis.

For newborn males diagnosed with hydronephrosis, circumcision may be associated with a significantly lower rate of urinary tract infections (UTI), according to research published in Pediatrics.

MarketScan data, an employer-based claims database, were used to identify 5561 male infants with hydronephrosis or hydronephrosis-related diagnoses within the first 30 days of life, 2386 (42.9%) of whom underwent newborn circumcision and 3175 (57.1%) of whom were uncircumcised. Rates of UTI within the first year of life were assessed comparing circumcised vs noncircumcised status, as well as adjusting for geographic region of care, insurance type, year of birth, and infant comorbidity.

Circumcision was associated with decreased risk of UTI in boys with hydronephrosis (odds ratio [OR], 0.36; 95%, CI 0.29-0.44) and healthy cohorts (OR, 0.32; 95% CI, 0.21-0.48).

Circumcision was associated with reduced risk of UTI with regard to specific hydronephrosis diagnoses, as well:  isolated hydronephrosis (OR, 0.35; 95% CI, 0.26-0.46), vesicoureteral reflux (OR, 0.35; 95% CI, 0.23-0.54), and ureteropelvic junction obstruction (OR, 0.35; 95% CI, 0.20-0.61).

The investigators caution that using an administrative database limited the inference of disease severity; however, they believe the findings to be representative of a typical hydronephrosis population and that “it is unlikely that the boys with severe hydronephrosis would be driving our findings.”

The results did, however, show an association between newborn circumcision and reduced UTI risk over the first year of life for boys with hydronephrosis, and this association remained consistent across hydronephrosis diagnoses. Further work is still required to define the associations when stratified for UTI severity, but “these results are hypothesis generating and may guide future prospective studies for this population” and “aid pre- and postnatal counseling regarding the patient-centered risks and benefits of circumcision.”

Reference

>Ellison JS, Dy GW, Fu BC, Holt SK, Gore JL, Merguerian PA. Neonatal circumcision and urinary tract infections in infants with hydronephrosis. Pediatrics. 2018;142:e20173703.

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