Pediatric emergency medicine trisk 2562 2562

Complications from circumcision are rare, and in the newborn, typically occur 2
to 5 times per 1,000 procedures. Most common complications include bleeding,
particularly if there is an underlying coagulopathy. For minor bleeding, treatment
includes manual pressure and a compression dressing. Circumferential dressings
need to be monitored for penile ischemia or urinary retention. If bleeding
continues and a specific bleeding vessel can be identified, treatment includes
topical administration of lidocaine with epinephrine and/or sutures. If bleeding is
generalized and persistent, the infant should be evaluated for a coagulopathy with
complete blood count, and coagulation studies.
Wound infection is another infrequent complication of circumcision. It is
typically localized, with evidence of local redness, irritation, or drainage. If
localized, treatment includes topical antibiotic ointment, although caregivers
should be educated on generalized symptoms of fever, irritability, or lethargy. If
present, infants with generalized symptoms should be evaluated for sepsis with
blood, urine, and CSF cultures and parenteral antibiotics.
Surgical complications of the procedure can include injury to the urethra or
glans. If injury is suspected, urgent pediatric urology consultation should be
obtained. If the circumcision has not been completed, any prepuce or redundant
skin should be left intact as this tissue may be used in the repair. Similarly, if
there is evidence of hypospadias, circumcision should be deferred and referred to
pediatric urology, for repair. Urethrocutaneous fistulas can also result from
circumcision, although these can be corrected as an outpatient procedure several
months after the initial procedures. If the glans is injured or amputated during the
procedure, the severed tissue should be wrapped in saline-soaked gauze, placed
indirectly on ice. An emergent pediatric urology consult should be obtained, as
there have been reports of successful reattachment if it is performed within an
hour of injury. Additional glans injury can occur if the Plastibell ring, which
normally sits over the glans for several days until the skin sloughs and ring falls
off, is displaced. If the ring cannot be removed easily, it may need to be removed
used ring cutters, particularly in the setting of constriction or ischemia.
Vaginal Discharge

Newborn females may present with either a milky white or blood-tinged vaginal
discharge. Both can be attributed to withdrawal from maternal hormones, and
need nothing more than conservative management, observance, and reassurance
to the parents. Occasionally, a girl with prolapsed urethra will present with “blood
in the diaper.” The prolapsed urethra is recognizable as an annular, beefy red or
purple mass between the labia.