Analgesia for neonatal circumcisions: Effects on behavior and mother/infant interactions

In order to evaluate the effects of acetaminophen on neonates during a circumcision, after a circumcision, and during a post-circumcision mother-infant feeding interaction, a double-blind, placebo controlled study was designed. Groups were randomly assigned. Heart rate and behavioral indicators were observed during three different times (pre-circumcision, circumcision and post-diaper/dressing change) and mother-infant interactions were measured at pre-circumcision and post-circumcision using the Nursing Child Assessment Feeding Scale.;Repeated ANCOVA for mother-infant interactions revealed significant group differences. Neonates in the analgesia group demonstrated clearer cues and were more responsive to their mothers. The more responsive and alert neonates in the analgesia group elicited more responsive behaviors from their mothers. A significant group difference was found in mothers' behaviors. Mothers of neonates who received the analgesia were more sensitive to their neonates and demonstrated significantly more social-emotional growth fostering behaviors.;Significant time effects were found for heart rate and crying from pre-circumcision to circumcision in both groups and the placebo group demonstrated significantly more crying at the post-diaper/dressing change. These findings suggest that both groups of neonates experienced some degree of pain during the circumcision, while only the placebo group demonstrated some degree of pain at the post-diaper/dressing change. While repeated ANCOVA approached significance at the post-diaper/dressing change, group differences between the analgesia group and the placebo group at the circumcision time and at the post-diaper/dressing change time were not found.;These findings reinforce the reciprocal, synchronous nature of mother-infant interaction during the early post-partum period and the need for pain control during and after circumcisions to promote optimal mother-infant interactions. The significant impact on mother-infant interactions suggests that some pain reduction did occur for the analgesia group. If an analgesia reduces some of the stress associated with circumcisions, is safe to use, and optimizes the ability of neonates to interact, then it should be used to enhance mother-infant interactions during and after circumcisions to allow some pain control.