Top 10 Most Read of 2016


We're saying so-long to 2016, and looking ahead with positive aspirations for a fresh, new 2017!

In case you are new to Saving Our Sons, or missed one of these much-appreciated items along the way, the following articles are the 10 most read at SavingSons.org this past year. It is our hope that you find something empowering or useful while you're here at SOS.


















A resource list for parents new to the topic


And the #1 most read item at Saving Our Sons this year is a piece put together by our friend and fellow baby-saver, the late Jonathon Conte. His passing in May 2016 was heartbreaking for so many people whose lives he touched, yet his influence and impact lives on. Note that U.S. hospitals are not required to keep data on newborn genital cutting, and this makes current year-to-year rates difficult to obtain.


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Connect locally and join in discussions: 



Circumcision Regret: The Hardest Conversation With My Son

By Alex Coper © 2016


Circumcision Regret: The Hardest Conversation With My Son


Tonight I had the hardest conversation ever.

My boys, ages 7 and 1, took a bath together (rare), and my oldest son told me that my toddler may have a rash because the end of his penis was pink (a normal shade, I wasn't concerned). He then asked me why his brother's penis 'looked different' from his.

I grimaced, but told him, "When you were a baby, Mommy and Daddy didn't know any better, and the doctor told us it was needed, so we got you circumcised, and I'm very sorry."

He asked what that was, and (not having time to pre-plan my response), I told him that there was 'extra skin' that was cut off his body. He asked why my toddler has this still, and I replied, "Because we found out it is better if you do have it. But it's okay now that you don't -- your penis is fine." [I panicked in this moment because I didn't want my son to think there is something wrong with him.]

He looked at my toddler's penis and said slowly, "That must have hurt..."

I replied, "It did, but the doctor told Mommy and Daddy that it didn't, and we didn't find out until later that he lied to us."

My son thought for a moment, "Daddy has the skin."

"I know," I said. [My husband was circumcised at birth, but has restored.]

"So why did you let the doctor cut mine?"

"I don't know son, we didn't research it, so I didn't know not to. We're very sorry. Now Mommy researches EVERYTHING."

"Did I cry?"

"Probably. I wasn't there, and neither was Daddy. They wouldn't let us see you."

"Did I bleed?"

"Yes..."

I let him think on it, and I could tell he was getting angry. (😢) Very angry.

"Momma, this is my penis. Why did you let them cut me?"

I broke down crying and just apologized over and over...

My son then bent down and gave me a hug, and said, "It's okay Momma. I know you and Daddy didn't know, but I hate that doctor. I want to punch him." I told him that honestly the doctor probably didn't know any better either, but now doctors are learning too. He asked if others had theirs cut, and I told him that many boys do -- as far as I know all of his friends were, because their parents didn't know any better either.

Then he asked if his baby cousin would be, and I said probably. "Mommy tried to talk with them, but they wouldn't listen."

Then it was my son who started crying and saying he wishes they would listen to me...

After I stopped us both (I started crying again too) he asked me if he could see my toddler's 'extra skin.' I told him no - that would pull and hurt him, and that he will pull it on his own when he's old enough. "We don't touch it except to wipe the outside like a finger when he needs it."

He asked what God said, and I told him, "God said to leave babies perfect, but Mommy hadn't read that part of the Bible when you were born." (Easiest way to explain that, I figured.) He asked if doctors had read those things, and I told him that I didn't know if his doctor had or not, but I would assume not.

Then he asked if he could see the 'circus-in-him' (circumcision). I very hesitantly said yes, there are videos of it being done to others... And he said he wanted to see.

So while he was getting ready for bed I dried off my toddler and found an educational video of how the procedure is performed online, and we watched it together.

He said, "It looks painful, but the baby didn't cry." I told him that it was just a demonstration, that I didn't want to hear a baby cry, and didn't think he should either. He said okay -- he just wanted to know how much it hurt him.

I asked him if he remembered when he slammed his fingers in the door (it took off skin), and he said yes. I told him that it hurt worse than that. He got quiet again, and then said he would never 'circus-in-him' his babies. GOOD, I said.

I apologized again, and we hugged. Later on he asked me if girls were cut, and I said no, and he concluded with, "That's not fair that they cut boys but not girls..." I said that's true -- and it is "one reason Mommy and so many others are telling people to not cut anyone." He said okay, and has not spoken about it again.

I wanted to share this experience from our day so that regret parents like me would know what I personally said when the topic came up with my older child, and some of the things he asked of me, to give a better idea of what may also come up in your family. Hopefully this will help in planning what you'd like to say to your own son, so you are more prepared than I was.


Read more from parents raising both intact and circumcised sons at: 
DrMomma.org/2010/05/i-circumcised-my-son-healing-from.html

Explore further information on the topic of genital autonomy and benefits of keeping your son intact:
SavingSons.org/2014/12/should-i-circumcise-pros-and-cons-of.html


♥         ♥          ♥         ♥

Happy Holidays! #i2


☃ Since Saving Our Sons began in 2008, our efforts have been led by a handful of volunteers and educators striving to empower parents, and make life better for babies (and the children and men they become). While the online SOS community has grown to 83,000+, and includes a wide and diverse number of people, there is still just a small number handling everything here at 'home base' -- and keeping the underlying foundation of SOS a positive, proactive and pro-intact one. It is testimony of the impact and ripple effect that merely a few can have with steadfast devotion, healthy action, and a pouring of hearts and personal resources into the cause.  

With this in mind, we *love* hearing from families who have found SOS over the years and had their lives positively impacted in one way or another. It is a blessing to correspond with you, to work in unison together in this global effort, as well as at the grassroots level, and we always look forward to hearing from you.

If you are sending greetings at this time of year, we would love to hear from you. ❤

Write if you wish to:

Saving Our Sons
P.O. Box 1302
Virginia Beach, VA 23451 

We will write back. :)

❄ Have a blessed holiday season. ❄

~~~~

To those who say, 'He is just fine!'

By Sierra Owen © 2016



Dear every person who says 'he was cut and he is just fine,'

-When he was a days old newborn, craving the warmth and smell of his mommy, taken and strapped arm and leg to a cold plastic board, no, he wasn't fine. He was afraid.

-While he lay there, strapped firmly in place, unable to see or hear or feel the safety of his mommy, when his whimpers and cries did not bring her, he wasn't fine. He was alone.

-When the cold metal probe was forced into the membrane between his penis and foreskin, he wasn't fine. He felt every rip and tear.

-When the physician used a scalpel and clamp to cut his sensitive genitals without adequate pain relief of any kind, he wasn't fine. He was in excruciating pain.

-When he was screaming and choking, gasping for air while feeling his genitals ripped, clamped, and cut from his body, he wasn't fine. He had a sugar coated binky shoved in his mouth to stifle his cries.

-When his tiny little body could not handle the pain anymore and went into shock, his screams silenced, but he wasn't fine. He was broken.

-When he was handed back to his beloved mommy, but could still feel the excruciating pain of a fresh open wound on his delicate genitals, bathed in urine with every wet diaper, caked in feces with every bowel movement, he wasn't fine. He was in pain, with no way to know why.

-When he was hungry, but hurting so much that he couldn't bring himself to eat, he wasn't fine. He was suffering.

-When his hungry, painful little body could take no more, he fell asleep, but he wasn't fine. He was depleted.

-With every diaper change, the air hurt his extremely sensitive glans without the protection of his foreskin. He cried, he wasn't fine. He spent months in constant pain.

-When every erection as a small child brought him more pain, with the tightening of scar tissue and the stretching of not enough skin, he wasn't fine. Normal things became painful experiences.

-When he begins having sex, and has no idea of the feelings robbed from him, he isn't fine, he is experiencing a beautiful event in black and white.

-When he finds out he is having a son, and insists his baby be forced to undergo the same cruel experience because 'he had it done and is just fine,' he isn't fine. He is confused, defensive, and in denial. He is angry because how dare anyone tell him that his penis isn't normal! He is angry because he cannot bear to think of himself as damaged. He is angry because his lifelong 'normal' is in question. So he repeats the cycle of pain with a new generation, because pride is too big a pill to swallow, and being different is a terrifying thing. No, he isn't fine. Break the cycle, protect their tiny little bodies. ♂


For additional information see: Should I Circumcise My Son? The Pros and Cons

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As the rate of boys who remain INTACT rises, what will you tell your son?


One day soon all boys will remain intact... what will we then tell our circumcised sons?

The rate at which baby boys have their genitals cut at birth for non-medical reasons in the United States is a statistic that varies from one study to the next. Even among advocates for genital autonomy, or from one CDC-organized study to the next, there is not a specific agreed-upon figure representing the rate at which American boys go home healthy and whole today. One thing is certain, however, and that is that with the continued spread of accurate information, the rise in research-based education, and the empowerment of parents (especially birthing mothers), there is also an annual rise in the number of young boys growing up intact.

Today's boys will know whether or not they have their full, functioning genitals, and it is statistically very likely that boys will grow up through the 2020s and beyond in many parts of the United States surrounded by intact peers. Those who are cut at birth are becoming a minority nationally, as they have long time been globally.

Statistics cited in this info graphic above are pulled from a CDC studies and reports, one of which (CDC 2010) was touted as the "most comprehensive" study conducted to date. Figures below were presented from this study by the CDC at the 2010 International AIDS Conference in Vienna.

Study findings as presented by the CDC at the International AIDS Conference, Vienna, 2010.

In our above graphic we rounded up to 40% cut (from 32.5%) in 2009 to allow for those boys circumcised in a manner that was not otherwise covered by insurance, or performed in a hospital setting. This was done in part because of the vehement outcry by some genital autonomy advocates in 2010 who were disgruntled at the "low" 32% rate.

Further reading on this figure:

Steep Drop Seen in Circumcisions in U.S. [New York Times]
NYTimes.com/2010/08/17/health/research/17circ.html

The Circumcision Reference Library (on this statistic and others):  CIRP.org/library/statistics/USA

32% of U.S. Baby Boys Circumcised in 2009: A Response to Critics Questioning the CDC Reported Rate: http://www.DrMomma.org/2011/09/32-of-us-baby-boys-circumcised-in-2009.html

This same CDC study did not address genital cutting rates of infants in 1999, so for this date's figure in the above graphic, we took the next "most comprehensive" studies, also put together by the CDC on U.S. hospital discharge rates of newborn circumcision, and looked at the 2009 figure. The rates found in these studies for 1999 range from 61.5% to 63.5% of baby boys cut. For the sake of counting whole bodies kept intact that year, we rounded to 6 out of 10 being cut, or 4 of 10 boys remaining intact.

SOURCE: CDC/NCHS, National Hospital Discharge Survey, 1979-2010.

Further reading on this figure:

Estimated number of male newborn infants discharged from short-stay hospitals, and percentage circumcised during birth hospitalization, by geographic region: https://www.cdc.gov/nchs/data/hestat/circumcision_2013/circumcision_2013_table.pdf

Trends in In-Hospital Newborn Male Circumcision: https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6034a4.htm

The Circumcision Reference Library (on this statistic and others):
http://www.cirp.org/library/statistics/USA

Trends in In-Hospital Newborn Male Circumcision, CDC Weekly September 2, 2011/60(34);1167-1168

Regardless of the actual percentage of boys who go home intact today, one basic truth stands firm: there is no medical reason to amputate the prepuce from any healthy newborn baby, regardless of sex. And there is especially no medical justification to perform this damaging surgery in a routine act of practice.




Infant Circumcision Potential SIDS Factor


A recent publication in the Frontiers in Neurology, expands on the growing body of neurological examination of extreme pain and trauma in infancy, and soon after birth, and its triggering implication on SIDS. In "A 'Wear and Tear' Hypothesis to Explain Sudden Infant Death Syndrome" Eran Elhaik presents the following material on infant genital cutting in the United States and its relation to the atypically high SIDS rate in the U.S.

Abstract (excerpt)

We also predict that neonatal male circumcision will account for the SIDS gender bias and that groups that practice high male circumcision rates, such as USA whites, will have higher SIDS rates compared to groups with lower circumcision rates. SIDS rates will also be higher in USA states where Medicaid covers circumcision and lower among people that do not practice neonatal circumcision and/or cannot afford to pay for circumcision. We last predict that winter-born premature infants who are circumcised will be at higher risk of SIDS compared to infants who experienced fewer nociceptive exposures.

Background (excerpt)

Circumcision is one of the most common elective surgical procedures in the world and is performed primarily on males (56). Female circumcision is practiced in nearly 30 African countries, some Southeast Asian and Middle Eastern countries, and in immigrant communities in Europe and North America (57). Despite its relevancy, female neonatal circumcision will not be discussed here since in most western countries it is illegal and thereby under-reported and we lack SIDS data for the remaining countries. In North America, ~1.2 million male infants are circumcised every year (58) often within the first 2 days of life (59). Although not requiring general anesthesia, circumcision is an intensively painful procedure requiring adequate analgesia (60). Circumcision is associated with intraoperative and postoperative risks, including bleeding, shock, sepsis, circulatory shock, and hemorrhage (61–63) that can result in death (63, 64).

Infant deaths following religious neonatal circumcision have been known for at least two millennia (65). Talmud (the central text of Rabbinic Judaism) sages ruled in the first centuries A.D. that mothers with two children who have died following the surgery should receive an exemption from circumcising their infants. During the nineteenth century, developments in medical knowledge on one hand and the rise of Jewish “Enlightenment” on the other hand, brought many Jews to reject the authority of the Talmud and with that the practice of circumcision. A new wave of accusations toward Jewish circumcisers (mohels) and rabbis of infant deaths following circumcision soon appeared and prompted community leaders to appeal to the governing authorities to forbid this practice – efforts that were countered by rabbis’ threats to ban the admission of uncircumcised Jewish children from Jewish schools. The fierce arguments about the necessity of the procedure last to this day and led many Jews to opt their infants out of the procedure, including Theodor Herzl, one of the fathers of modern political Zionism (66). In the UK, Gairdner (67) estimated an annual rate of 16 per 100,000 circumcision-associated deaths for boys under 1-year old in a study that influenced the British government to exclude circumcision coverage from the National Health Service. Remarkably, the SIDS rates in the UK (0.38 per 1000) are much lower than in the USA (0.55 per 1000) (10) where most male infants are circumcised (58). Moreover, most of the deaths in the USA occur in non-Hispanic blacks (83% higher death rate compared with non-Hispanic whites). SIDS rates were 44% lower for Hispanics compared with non-Hispanic whites (68). Interestingly the circumcision rates among Hispanics are about half that of the two other groups (69).

Circumcision contributes to the rise in allostatic load and increased risk for SIDS through multiple conduits. Circumcision produces crush and incisional injuries during amputation, resulting in damage to normal prepuce tissue, the associated nerves, and blood vessels. Wound healing manifested by hyperaemia and swelling at day 7 postoperative is observed in 70% of infants with minimally retractile prepuces seen in infants circumcised before 1 year of age with subsequent bacterial carriage of skin commensals (70). Circumcised males have increased pain responses to childhood immunization 4–6 months post-surgery (71, 72) consistent with central sensitization (73). The abnormal development of sensory pathways in the developing nervous system elicited by the pain during critical postnatal periods is manifested in later life following nociceptive reexposure by abnormal sensory thresholds and pain responses that are not restricted to the original site of postnatal trauma (74–76). Neonatal nociceptive exposure induces long-term hypoalgesia or hyperalgesia depending on the nature and timing of the trauma (54, 77) and is consistent with surgery and pain adversely impacting neurodevelopment independent of anesthetic (76).

Post-circumcision, tactile hypersensitivity increases due to post-surgical and -traumatic mechanisms that contribute toward allostasis and the risk of SIDS. This is evident by the increase in toll-like receptor 4 (78) associated with post-circumcision wound healing, which is also observed in post-surgical tactile hypersensitivity in males and dependent on testosterone (79). Following peripheral nerve injury, the purinergic receptors in the spinal cord microglial cells release BDNF (79) and mitogen-activated protein kinase p38 (80) that contribute to neuropathic pain and tactile hypersensitivity. Due to their testosterone dependency, they are seen only in males (79). The testosterone surge occurring during the first 2- to 4-month period may increase susceptibility to the initial stages of infection and is consistent with the peak in SIDS mortality (81).

Male neonates subjected to circumcision can experience severe cardiorespiratory pain responses, including cyanosis, apnea, increased heart rate (82), and increased pitch (fundamental frequency) of cry (as high as 800–2000 Hz) associated with decreased heart rate variability, i.e., decreased vagotonia (83–85), a likely risk factor for SIDS. Other circumcision sequelae of sufficient severity to require emergency room evaluation or hospital admission and contribute toward allostasis include infection, urinary retention, inflammatory redness and swelling ascribed to healing (86, 87), and amputation/necrosis of the glans (88). Behavioral abnormalities, such as eating disturbance and disturbed sleep, are also the consequence of pain exposure (89).

Postoperative circumcision pain of ample severity to require analgesia is expected for about 10 days for healing with incomplete wound healing past day 14 seen in up to 6% of infants depends on the device used to amputate the foreskin (88), which is also associated with various adverse events (56, 90). The overall complication rate for circumcision ranges from 0.2 to 10% with many USA physicians performing the procedure without formal training, being unaware of contraindications, and incapable of handling post-op complications (56, 91, 92). Lower complication rates for early and late adverse events have been attributed to underreporting with late adverse events mistakenly not attributed to circumcision (92, 93). Consequently, the low number ascribed to circumcision as the cause of death (63) may be underreported and erroneously attributed to other causes, such as sepsis (94) or SIDS.

One mechanism by which circumcision may elicit SIDS concerns the inhibition of nerves involved in nociception processing that produces prolonged apnea while impairing cortical arousal. Neonatal surgery that traumatizes peripheral nerves with associated tactile hypersensitivity followed by a subsequent surgery later in development can increase spinal cord microglia signaling and elicit persistent hyperalgesia (80). It can also produce post-surgical hyperalgesia that subsequently alters postnatal development of the rostral rostroventral medulla (RVM), which controls the excitability of spinal neurons by spinally projecting neurons from the nucleus paragigantocellularis lateralis (PGCL) and the nucleus raphe magnus. Alterations in the RVM result in a descending inhibition of spinal reflex excitability on nociception (95). Inhibition of RVM neurons was shown to limit the duration of the laryngeal chemoreflex and produce prolonged apnea that contributes toward SIDS, particularly when combined with stimuli that inhibit respiration (96). In SIDS, norepinephrine, which depresses respiration, is increased in the PGCL and serotonin 5-HT1A receptor that mediates nociceptive stimuli in the brainstem (97) and decreased in the raphe nuclei and the arcuate nuclei (98). The reduction in 5-HT1A receptors observed in the brainstem of SIDS infants prompts the hypothesis that SIDS is caused by a brainstem abnormality that impairs the ability to generate protective responses to life-threatening challenges (99, 100). This hypothesis, however, does not explain why SIDS peaks at 2–4 months, rather than in an earlier GA (101). Orexin is another important regulator of both pain and sleep dysfunction. Orexin knockout mice presented greater degree of hyperalgesia induced by peripheral inflammation and less stress-induced analgesia than wild-type mice (102). In the rostral ventrolateral medulla and PGCL, orexin receptors are expressed in sympathoexcitatory bulbospinal neurons (103). A significantly decreased orexin immunoreactivity in the hypothalamus and pontine nuclei was observed in SIDS infants (104).

Another mechanism that can explain the SIDS toll following circumcision is the loss of ~1–2 ounces (oz) of blood out of a total of ~11 oz that a 3,000 gram male newborn has (105), the equivalent of ~1–2 blood donations in an adult. Excessive bleeding is highly common in circumcision with reports range from 0.1 to 35% (91, 106) in neonates. However, even moderate bleeding puts the infant as risk, and, being an inherent part of the procedure, it is not reported as a complication. Blood loss of 2–2.5 oz, ~15% of the total blood volume at birth, is sufficient to cause hypovolemia and death. Since a large fraction of newborns (26%), particularly premature infants, weigh much less than 3,000 grams (107), a smaller amount of blood loss may trigger hypovolemic shock. Therefore, when bleeding an infant of low birth weight or GA, the effect may be pathological resulting in a reduced blood pressure that has been associated with obstructive sleep apnea (OSA), a condition where the walls of the throat relax and narrow during sleep, interrupting normal breathing (108). It is, therefore, not surprising that most of the deaths following circumcision in high-income countries were due to bleeding (63). While it is accepted that failure of neural mechanisms causing arousal from sleep may play a role in at least some SIDS cases [e.g., Ref. (109)], it is unclear what causes the initial failure of the respiratory control (110). Comparing the breathing characteristics of 40 infants who eventually died of SIDS with 607 healthy controls, Kato and colleagues reported that SIDS infants have a greater proportion of obstructive and mixed apneic episodes than the control group (111). Although the frequency of these episodes decreased with age, the decrease was smaller in the SIDS infants than in the controls, in support of either immature or impaired respiratory control. Looking at the data by gender, however, shows that only boys exhibit a difference in apnea frequency in support of an impaired respiratory control (111), perhaps due to circumcision.

To date, circumcision in the USA, despite being the most common pediatric surgery, has not been subjected to the same systematic scientific scrutiny looking at immediate and delayed adverse effects, including pain [e.g., Ref. (112)], nor has circumcision status been included as part of a thorough SIDS investigation/registry or analyses [e.g., Ref. (2)] in spite of the male predominance of both neonatal circumcision and SIDS. However, based on assessment of risk of harms versus benefit, despite the latter including decreased risk of urinary tract infection (113), the Royal Australasian College of Physicians, the British Medical Association, the Canadian Paediatric Society (87), and several west European medical societies have recommended against routine neonatal circumcision (114), arguing that the benefits of circumcision to children are minimal, non-existent, or outweighed by the risks, and that circumcision is thereby unwarranted. The AAP’s recommendation in favor of this routine (115) has been widely criticized [e.g., Ref. (116)].


The Significance of the Allostatic Load Model for SIDS

Sudden infant death syndrome occurs when an infant dies suddenly, unexpectedly, and without a cause identified through a forensic autopsy or death-scene investigation. We speculate that SIDS is caused by prolonged and repetitive iatrogenic stressful, painful, or traumatic experiences during critical development stages that constitute allostatic overload (156). Over the past years, allostatic load models were proposed to explain several leading medical conditions, including mental health disorders (157, 158), preterm birth (159), and chronic stress (160).

While the infant’s first environment is typically romanticized as peaceful, painless, hygienic, safe, and harmless, in practicality it may be anything but that. Already in the uterus, the fetus may be exposed to maternal substance use (e.g., smoking and drug use) associated with SIDS (19, 161). During a prolonged hospitalization in the Neonatal Intensive Care Unit that follows a preterm birth, infants may be exposed to extended and repeated pain, which thier unstable and immature physiological systems are unable to offset and will potentially render them more vulnerable to the effects of repeated invasive procedures (38). Neonatal circumcision typically involves maternal separation, pain, bleeding, and shock and, like any operation, puts the infant at risks of hemorrhage and sepsis even when anesthetic is used (67). The long-term consequences of circumcision include, among else, greater pain response to routine immunizations within the few months past birth (72). During winter time, the infant is at risk of infection and illnesses that grows with the number of household members, particularly older children (126), which explains why an elevated immune response is one of the hallmarks of SIDS (123, 128). Other common stressors may include birth trauma, birth injury, traumatic injury, life-threatening event, inadequate nutrition, heel lances, prolonged institutionalization, skin breaks, and air pollution – all contribute to the build-up of toxic allostatic load.

Our model represents a major departure from previous models, such as the “three interrelated causal spheres of influence model” that requires two out of three factors to act simultaneously (subclinical tissue damage, deficiency in postnatal development of reflexes and responses, and environmental factors) (162), or the more popular “triple-risk model,” which advocates that the combined effect of three factors (vulnerable infant, critical development period, and environmental stressors) causes SIDS (163). Our model posits that any infant may succumb to SIDS when the combined and cumulative effect of the environmental stressors has exceeded their tolerance level shaped by their unique genetic and environmental factors (Figure ​(Figure11).

Testing the Hypothesis (excerpt)

Neonatal Circumcision is a Risk Factor for SIDS

Double-blinded case–control human studies aiming to test our hypothesis are unfeasible due to ethical consideration and the difficulties in matching cases and controls (19). Fortunately, the prepuce has been well conserved throughout mammalian evolution (164), which attests to its functional importance, and allows carrying out animal studies. Our hypothesis can be tested by circumcising the prepuce of mammalian animal models and measuring whether an excess of SIDS is observed among cases when compared with untreated controls. Curiously, none of the studies purporting the “benefits” of neonatal circumcision has ever been demonstrated using animal models, which are the only viable means to carry out double-blinded case–control studies assessing the short- and long-term health impacts of circumcision. In humans, we can expect higher SIDS rates in Anglophone countries that adopted male neonatal circumcision in the nineteenth century, compared to Iberio-American that traditionally have opposed circumcision (66). We can also expect a higher incidence of SIDS in USA states where Medicaid, the most common health insurance, covers circumcision, compares to states where this procedure is not covered by Medicaid after accounting for culture and socioeconomic status. The data for such study can be obtained from the CDC’s SIDS registry (165). Finally, we can compare the circumcision status of SIDS victims versus healthy controls, obtained through autopsies and questionnaires, respectively. New genetic tools, such as Case-control matcher (http://www.elhaik-lab.group.shef.ac.uk/ElhaikLab/index.php), based on biogeographic ancestry tools [e.g., Ref. (166)], can be instrumental in optimizing case–control matches by identifying individuals that have similar population structure and genetic background and minimizing the bias studies due to population stratification.

Male Neonatal Circumcision Accounts for a Large Fraction of the Gender Bias in SIDS

We speculate that the male bias in SIDS observed in western countries may be due to both natural protections that render females more resilient to nociceptive stimuli and legal-cultural ones that protect females from circumcision in these countries. The weights of these two factors are unknown, yet we expect the gender deviations from even proportions in SIDS to be correlated with circumcision rates. Consequently, large male bias is expected in societies that practice neonatal circumcision whereas smaller bias is expected in societies that circumcise both males and females or avoid it altogether.

Circumcised Premature Infants Are at High Risk

We predict that circumcised premature infants would be at higher risk for SIDS compared with intact preterm infants. This can be tested by an analysis of hospital records after properly matching cases with controls (19).

Additional complications that should be considered when testing these predictions in humans include misclassification of SIDS to other categories, inconsistent reports of SIDS over time in certain countries due to changes in definitions, inconsistent reports of circumcision (167), and the absence of legislation requiring an autopsy or thorough death-scene investigation.

Source

Elhaik, E. (2016). A “Wear and Tear” Hypothesis to Explain Sudden Infant Death Syndrome. Frontiers in Neurology, 7, 180.


References Cited

1. Mitchell EA, Krous HF. Sudden unexpected death in infancy: a historical perspectiveJ Paediatr Child Health (2015) 51:108–12.10.1111/jpc.12818  [PubMed] [Cross Ref]
2. Camperlengo L, Shapiro-Mendoza CK, Gibbs F. Improving sudden unexplained infant death investigation practices: an evaluation of the Centers for Disease Control and Prevention’s SUID Investigation Training AcademiesAm J Forensic Med Pathol (2014) 35:278–82.10.1097/PAF.0000000000000123  [PubMed] [Cross Ref]
3. Garstang J, Ellis C, Sidebotham P. An evidence-based guide to the investigation of sudden unexpected death in infancyForensic Sci Med Pathol (2015) 11:345–57.10.1007/s12024-015-9680-x  [PubMed][Cross Ref]
5. Opdal SH, Rognum TO. The sudden infant death syndrome gene: does it exist? Pediatrics (2004) 114:e506–12.10.1542/peds.2004-0683  [PubMed] [Cross Ref]
6. Horne RS, Hauck FR, Moon RY. Sudden infant death syndrome and advice for safe sleepingBr Med J(2015) 350:h1989.10.1136/bmj.h1989  [PubMed] [Cross Ref]
7. Hauck FR, Tanabe KO. International trends in sudden infant death syndrome: stabilization of rates requires further actionPediatrics (2008) 122:660–6.10.1542/peds.2007-0135  [PubMed] [Cross Ref]
8. Hakeem GF, Oddy L, Holcroft CA, Abenhaim HA. Incidence and determinants of sudden infant death syndrome: a population-based study on 37 million birthsWorld J Pediatr (2015) 11:41–7.10.1007/s12519-014-0530-9  [PubMed] [Cross Ref]
9. Waters KA. SIDS symposium–a perspective for future researchPaediatr Respir Rev (2014) 15:285–6.10.1016/j.prrv.2014.09.005  [PubMed] [Cross Ref]
10. Hauck FR, Tanabe KO. International trends in sudden infant death syndrome and other sudden unexpected deaths in infancy: need for better diagnostic standardizationCurr Pediatr Rev (2010) 6:95–101.10.2174/157339610791317241 [Cross Ref]
11. Hunt CE, Darnall RA, McEntire BL, Hyma BA. Assigning cause for sudden unexpected infant deathForensic Sci Med Pathol (2015) 11:283–8.10.1007/s12024-014-9650-8 [PMC free article]  [PubMed][Cross Ref]
12. Sauber-Schatz EK, Sappenfield WM, Shapiro-Mendoza CK. Comprehensive review of sleep-related sudden unexpected infant deaths and their investigations: Florida 2008Matern Child Health J (2015) 19:381–90.10.1007/s10995-014-1520-1  [PubMed] [Cross Ref]
13. Hauck FR, Tanabe KO, McMurry T, Moon RY. Evaluation of bedtime basics for babies: a national crib distribution program to reduce the risk of sleep-related sudden infant deathsJ Community Health (2015) 40:457–63.10.1007/s10900-014-9957-0 [PMC free article]  [PubMed] [Cross Ref]
14. Byard R, Beal S. Has changing diagnostic preference been responsible for the recent fall in incidence of sudden infant death syndrome in South Australia? J Paediatr Child Health (1995) 31:197–9.10.1111/j.1440-1754.1995.tb00785.x  [PubMed] [Cross Ref]
15. Malloy MH, MacDorman M. Changes in the classification of sudden unexpected infant deaths: United States, 1992–2001Pediatrics (2005) 115:1247–53.10.1542/peds.2004-2188  [PubMed] [Cross Ref]
16. Läer K, Dörk T, Vennemann M, Rothämel T, Klintschar M. Polymorphisms in genes of respiratory control and sudden infant death syndromeInt J Legal Med (2015) 129:977–84.10.1007/s00414-015-1232-0  [PubMed] [Cross Ref]
17. Poetsch M, Todt R, Vennemann M, Bajanowski T. That’s not it, either-neither polymorphisms in PHOX2B nor in MIF are involved in sudden infant death syndrome (SIDS)Int J Legal Med (2015) 129:985–9.10.1007/s00414-015-1213-3  [PubMed] [Cross Ref]
18. Jensen LL, Banner J, Byard RW. Does β-APP staining of the brain in infant bed-sharing deaths differentiate these cases from sudden infant death syndrome? J Forensic Leg Med (2014) 27:46–9.10.1016/j.jflm.2014.07.006  [PubMed] [Cross Ref]
19. Hunt CE, Hauck FR. Sudden infant death syndromeCan Med Assoc J (2006) 174:1861–9.10.1503/cmaj.051671 [PMC free article]  [PubMed] [Cross Ref]
20. Phillips DP, Brewer KM, Wadensweiler P. Alcohol as a risk factor for sudden infant death syndrome (SIDS)Addiction (2011) 106:516–25.10.1111/j.1360-0443.2010.03199.x  [PubMed] [Cross Ref]
21. Trachtenberg FL, Haas EA, Kinney HC, Stanley C, Krous HF. Risk Factor Changes for Sudden Infant Death Syndrome After Initiation of Back-to-Sleep CampaignPediatrics (2012) 129:630–8.10.1542/peds.2011-1419 [PMC free article]  [PubMed] [Cross Ref]
22. Goldstein RD, Trachtenberg FL, Sens MA, Harty BJ, Kinney HC. Overall postneonatal mortality and rates of SIDSPediatrics (2016) 137:1–10.10.1542/peds.2015-2298  [PubMed] [Cross Ref]
23. Mage DT, Donner M. A unifying theory for SIDSInt J Pediatr (2009) 2009:368270.10.1155/2009/368270 [PMC free article]  [PubMed] [Cross Ref]
24. Sterling P. Allostasis: a model of predictive regulationPhysiol Behav (2012) 106:5–15.10.1016/j.physbeh.2011.06.004  [PubMed] [Cross Ref]
25. Fagiolini M, Jensen CL, Champagne FA. Epigenetic influences on brain development and plasticityCurr Opin Neurobiol (2009) 19:207–12.10.1016/j.conb.2009.05.009 [PMC free article]  [PubMed][Cross Ref]
26. McEwen BS, Gianaros PJ. Stress-and allostasis-induced brain plasticityAnnu Rev Med (2011) 62:431–45.10.1146/annurev-med-052209-100430 [PMC free article]  [PubMed] [Cross Ref]
27. McEwen BS, Gray JD, Nasca C. 60 years of neuroendocrinology: redefining neuroendocrinology: stress, sex and cognitive and emotional regulationJ Endocrinol (2015) 226:T67–83.10.1530/JOE-15-0121 [PMC free article]  [PubMed] [Cross Ref]
28. McEwen BS. Allostasis and allostatic load: implications for neuropsychopharmacologyNeuropsychopharmacology (2000) 22:108–24.10.1016/S0893-133X(99)00129-3  [PubMed] [Cross Ref]
29. McEwen BS, Seeman T. Protective and damaging effects of mediators of stress. Elaborating and testing the concepts of allostasis and allostatic loadAnn N Y Acad Sci (1999) 896:30–47.10.1111/j.1749-6632.1999.tb08103.x  [PubMed] [Cross Ref]
30. Katz DA, Sprang G, Cooke C. Allostatic load and child maltreatment in infancyClin Case Stud (2011) 10:159–72.10.1177/1534650111399121 [Cross Ref]
31. Walker SM. Neonatal painPaediatr Anaesth (2014) 24:39–48.10.1111/pan.12293 [PMC free article][PubMed] [Cross Ref]
32. Tye K, Pollard I, Karlsson L, Scheibner V, Tye G. Caffeine exposure in utero increases the incidence of apnea in adult ratsReprod Toxicol (1993) 7:449–52.10.1016/0890-6238(93)90089-P  [PubMed][Cross Ref]
33. Mueller BR, Bale TL. Sex-specific programming of offspring emotionality after stress early in pregnancyJ Neurosci (2008) 28:9055–65.10.1523/JNEUROSCI.1424-08.2008 [PMC free article][PubMed] [Cross Ref]
34. Page GG, Hayat MJ, Kozachik SL. Sex differences in pain responses at maturity following neonatal repeated minor pain exposure in ratsBiol Res Nurs (2011) 15:96–104.10.1177/1099800411419493 [PubMed] [Cross Ref]
35. Kudielka BM, Kirschbaum C. Sex differences in HPA axis responses to stress: a reviewBiol Psychol(2005) 69:113–32.10.1016/j.biopsycho.2004.11.009  [PubMed] [Cross Ref]
36. Paterson DS, Trachtenberg FL, Thompson EG, Belliveau RA, Beggs AH, Darnall R, et al. Multiple serotonergic brainstem abnormalities in sudden infant death syndromeJAMA (2006) 296:2124–32.10.1001/jama.296.17.2124  [PubMed] [Cross Ref]
37. Malloy M. Prematurity and sudden infant death syndrome: United States 2005–2007J Perinatol (2013) 33:470–5.10.1038/jp.2012.158  [PubMed] [Cross Ref]
38. Grunau RE, Holsti L, Peters JW. Long-term consequences of pain in human neonatesSemin Fetal Neonatal Med (2006) 11:268–75.10.1016/j.siny.2006.02.007  [PubMed] [Cross Ref]
39. Grunau RE, Whitfield MF, Petrie-Thomas J, Synnes AR, Cepeda IL, Keidar A, et al. Neonatal pain, parenting stress and interaction, in relation to cognitive and motor development at 8 and 18 months in preterm infantsPain (2009) 143:138–46.10.1016/j.pain.2009.02.014 [PMC free article]  [PubMed][Cross Ref]
40. Slater R, Fabrizi L, Worley A, Meek J, Boyd S, Fitzgerald M. Premature infants display increased noxious-evoked neuronal activity in the brain compared to healthy age-matched term-born infantsNeuroimage (2010) 52:583–9.10.1016/j.neuroimage.2010.04.253  [PubMed] [Cross Ref]
41. Anand K, Scalzo FM. Can adverse neonatal experiences alter brain development and subsequent behavior? Neonatology (2000) 77:69–82.10.1159/000014197  [PubMed] [Cross Ref]
42. Marcus DA. A review of perinatal acute pain: treating perinatal pain to reduce adult chronic painJ Headache Pain (2006) 7:3–8.10.1007/s10194-006-0267-5 [PMC free article]  [PubMed] [Cross Ref]
43. Cohen G, Katz-Salamon M, Malcolm G. A key circulatory defence against asphyxia in infancy – the heart of the matter! J Physiol (2012) 590:6157–65.10.1113/jphysiol.2012.239145 [PMC free article][PubMed] [Cross Ref]
44. Fyfe KL, Yiallourou SR, Wong FY, Odoi A, Walker AM, Horne RS. Gestational age at birth affects maturation of baroreflex controlJ Pediatr (2015) 166:559–65.10.1016/j.jpeds.2014.11.026  [PubMed][Cross Ref]
45. Fyfe KL, Yiallourou SR, Wong FY, Odoi A, Walker AM, Horne RS. The effect of gestational age at birth on post-term maturation of heart rate variabilitySleep (2015) 38:1635–44.10.5665/sleep.5064 [PMC free article]  [PubMed] [Cross Ref]
46. Fyfe KL, Odoi A, Yiallourou SR, Wong FY, Walker AM, Horne RS. Preterm infants exhibit greater variability in cerebrovascular control than term infantsSleep (2015) 38:1411–21.10.5665/sleep.4980 [PMC free article]  [PubMed] [Cross Ref]
47. Hays SR, Deshpande JK. Newly postulated neurodevelopmental risks of pediatric anesthesia: theories that could rock our worldJ Urol (2013) 189:1222–8.10.1016/j.juro.2012.11.090  [PubMed] [Cross Ref]
48. Rappaport BA, Suresh S, Hertz S, Evers AS, Orser BA. Anesthetic neurotoxicity – clinical implications of animal modelsN Engl J Med (2015) 372:796–7.10.1056/NEJMp1414786  [PubMed] [Cross Ref]
49. Psaty BM, Platt R, Altman RB. Neurotoxicity of generic anesthesia agents in infants and children: an orphan research question in search of a sponsorJAMA (2015) 313:1515–6.10.1001/jama.2015.1149 [PubMed] [Cross Ref]
50. Nasr VG, Davis JM. Anesthetic use in newborn infants: the urgent need for rigorous evaluationPediatr Res (2015) 78:2–6.10.1038/pr.2015.58 [PMC free article]  [PubMed] [Cross Ref]
51. Warner DO, Flick RP. Anaesthetics, infants, and neurodevelopment: case closed? The Lancet (2015) 387:239–50.10.1016/S0140-6736(15)00669-8 [Cross Ref]
52. Morriss FH, Jr, Saha S, Bell EF, Colaizy TT, Stoll BJ, Hintz SR, et al. Surgery and neurodevelopmental outcome of very low birth weight infantsJAMA pediatrics (2014) 168:746–54.10.1001/jamapediatrics.2014.307 [PMC free article]  [PubMed] [Cross Ref]
53. Walker SM. Biological and neurodevelopmental implications of neonatal painClin Perinatol (2013) 40:471–91.10.1016/j.clp.2013.05.002  [PubMed] [Cross Ref]
54. Li J, Kritzer E, Craig PE, Baccei ML. Aberrant synaptic integration in adult lamina I projection neurons following neonatal tissue damageJ Neurosci (2015) 35:2438–51.10.1523/JNEUROSCI.3585-14.2015 [PMC free article]  [PubMed] [Cross Ref]
55. American Academy of Pediatrics and Canadian Paediatric Society. Prevention and management of pain in the neonate: an updatePediatrics (2006) 118:2231–41.10.1542/peds.2006-2277  [PubMed] [Cross Ref]
56. DeMaria J, Abdulla A, Pemberton J, Raees A, Braga LH. Are physicians performing neonatal circumcisions well-trained? Can Urol Assoc J (2013) 7:260–4.10.5489/cuaj.200 [PMC free article][PubMed] [Cross Ref]
57. UNICEF. Female Genital Mutilation/Cutting: A Statistical Overview and Exploration of the Dynamics of Change. UNICEF; (2013). Available from: http://www.data.unicef.org/corecode/uploads/document6/uploaded_pdfs/corecode/FGMC_Lo_res_Final_26.pdf
58. Weiss AJ, Elixhauser A. Trends in Operating Room Procedures in U.S. Hospitals, 2001–2011. Healthcare Cost and Utilization Project (HCUP) (2014). Available from: http://www.hcup-us.ahrq.gov/[PubMed]
59. American Pregnancy Association. Circumcision: Benefits, Procedures and Risks. (2015). Available from: http://americanpregnancy.org/labor-and-birth/circumcision/
60. Ward RM, Stiers J, Buchi K. Neonatal medicationsPediatr Clin North Am (2015) 62:525–44.10.1016/j.pcl.2014.11.012  [PubMed] [Cross Ref]
61. Weiss HA, Larke N, Halperin D, Schenker I. Complications of circumcision in male neonates, infants and children: a systematic reviewBMC Urol (2010) 10:2.10.1186/1471-2490-10-2 [PMC free article][PubMed] [Cross Ref]
62. Boyle GJ. Circumcision of infants and children: short-term trauma and long-term psychosexual harmAdv Sex Med (2015) 5:22–38.10.4236/asm.2015.52004 [Cross Ref]
63. Edler G, Axelsson I, Barker GM, Lie S, Naumburg E. Serious complications in male infant circumcisions in Scandinavia indicate that this always be performed as a hospital-based procedureActa Paediatr (2016) 105:842–50.10.1111/apa.13402  [PubMed] [Cross Ref]
64. Blackwell T. Ontario Newborn Bleeds to Death after Family Doctor Persuades Parents to Get Him Circumcised. (2015). Available from: http://news.nationalpost.com/health/ontario-newborn-bleeds-to-death-after-family-doctor-persuades-parents-to-get-him-circumcised
65. Leas BF, Umscheid CA. Neonatal herpes simplex virus type 1 infection and Jewish ritual circumcision with oral suction: a systematic reviewJ Pediatric Infect Dis Soc (2014) 4:126–31.10.1093/jpids/piu075 [PMC free article]  [PubMed] [Cross Ref]
66. Gollaher D. Circumcision: A History of the World’s Most Controversial Surgery. New York: Basic Books; (2001).
67. Gairdner D. The fate of the foreskin, a study of circumcisionBr Med J (1949) 2:1433–7.10.1136/bmj.2.4642.1433 [PMC free article]  [PubMed] [Cross Ref]
68. Mathews T, MacDorman MF. Infant mortality statistics from the 2009 period linked birth/infant death data setNatl Vital Stat Rep (2013) 61:1–28.  [PubMed]
69. Xu F, Markowitz LE, Sternberg MR, Aral SO. Prevalence of circumcision and herpes simplex virus type 2 infection in men in the United States: the National Health and Nutrition Examination Survey (NHANES), 1999–2004Sex Transm Dis (2007) 34:479–84.10.1097/01.olq.0000253335.41841.04 [PubMed] [Cross Ref]
70. Tarhan H, Akarken I, Koca O, Ozgü I, Zorlu F. Effect of preputial type on bacterial colonization and wound healing in boys undergoing circumcisionKorean J Urol (2012) 53:431–4.10.4111/kju.2012.53.6.431 [PMC free article]  [PubMed] [Cross Ref]
71. Taddio A, Goldbach M, Ipp M, Stevens B, Koren G. Effect of neonatal circumcision on pain responses during vaccination in boysThe Lancet (1995) 345:291–2.10.1016/S0140-6736(95)90278-3  [PubMed][Cross Ref]
72. Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccinationThe Lancet (1997) 349:599–603.10.1016/S0140-6736(96)10316-0 [PubMed] [Cross Ref]
73. Woolf CJ. Central sensitization: implications for the diagnosis and treatment of painPain (2011) 152:S2–15.10.1016/j.pain.2010.09.030 [PMC free article]  [PubMed] [Cross Ref]
74. Beggs S. Long-term consequences of neonatal injuryCan J Psychiatry (2015) 60:176–80.10.1177/070674371506000404 [PMC free article]  [PubMed] [Cross Ref]
75. Noel M, Palermo TM, Chambers CT, Taddio A, Hermann C. Remembering the pain of childhood: applying a developmental perspective to the study of pain memoriesPain (2015) 156:31–4.10.1016/j.pain.0000000000000001  [PubMed] [Cross Ref]
76. Ririe DG. How long does incisional pain last: early life vulnerability could make it last a lifetimeAnesthesiology (2015) 122:1189–91.10.1097/ALN.0000000000000660 [PMC free article]  [PubMed][Cross Ref]
77. Schwaller F, Fitzgerald M. The consequences of pain in early life: injury-induced plasticity in developing pain pathwaysEur J Neurosci (2014) 39:344–52.10.1111/ejn.12414 [PMC free article][PubMed] [Cross Ref]
78. Chen L, Guo S, Ranzer MJ, DiPietro LA. Toll-like receptor 4 plays an essential role in early skin wound healingJ Invest Dermatol (2013) 133:258–67.10.1038/jid.2012.267 [PMC free article]  [PubMed][Cross Ref]
79. Sorge RE, Mapplebeck JC, Rosen S, Beggs S, Taves S, Alexander JK, et al. Different immune cells mediate mechanical pain hypersensitivity in male and female miceNat Neurosci (2015) 18:1081–3.10.1038/nn.4053 [PMC free article]  [PubMed] [Cross Ref]
80. Schwaller F, Beggs S, Walker SM. Targeting p38 mitogen-activated protein kinase to reduce the impact of neonatal microglial priming on incision-induced hyperalgesia in the adult ratAnesthesiology (2015) 122:1377–90.10.1097/ALN.0000000000000659 [PMC free article]  [PubMed] [Cross Ref]
81. Moscovis SM, Hall ST, Burns CJ, Scott RJ, Blackwell CC. The male excess in sudden infant deathsInnate Immun (2014) 20:24–9.10.1177/1753425913481071  [PubMed] [Cross Ref]
82. O’Conner-Von S, Turner HN. American Society for Pain Management Nursing (ASPMN) position statement: male infant circumcision pain managementPain Manag Nurs (2013) 14:379–82.10.1016/j.pmn.2011.08.007  [PubMed] [Cross Ref]
83. Porter FL, Miller RH, Marshall RE. Neonatal pain cries: effect of circumcision on acoustic features and perceived urgencyChild Dev (1986) 57:790–802.10.2307/1130355  [PubMed] [Cross Ref]
84. Porter FL, Porges SW, Marshall RE. Newborn pain cries and vagal tone: parallel changes in response to circumcisionChild Dev (1988) 59:495–505.10.2307/1130327  [PubMed] [Cross Ref]
85. Stewart AM, Lewis GF, Heilman KJ, Davila MI, Coleman DD, Aylward SA, et al. The covariation of acoustic features of infant cries and autonomic statePhysiol Behav (2013) 120:203–10.10.1016/j.physbeh.2013.07.003 [PMC free article]  [PubMed] [Cross Ref]
86. Gold G, Young S, O’Brien M, Babl FE. Complications following circumcision: presentations to the emergency departmentJ Paediatr Child Health (2015) 51:1158–63.10.1111/jpc.12960  [PubMed][Cross Ref]
87. Sorokan ST, Finlay JC, Jefferies AL, Canadian Paediatric Society, Fetus and Newborn Committee, Infectious Diseases and Immunization Committee . Newborn male circumcisionPaediatr Child Health(2015) 20:311–5. [PMC free article]  [PubMed]
88. Mavhu W, Larke N, Hatzold K, Ncube G, Weiss HA, Mangenah C, et al. A randomized noninferiority trial of AccuCirc device versus Mogen clamp for early infant male circumcision in ZimbabweJ Acquir Immune Defic Syndr (2015) 69:e156–63.10.1097/QAI.0000000000000694 [PMC free article]  [PubMed][Cross Ref]
89. Mitchell A, Boss BJ. Adverse effects of pain on the nervous systems of newborns and young children: a review of the literatureJ Neurosci Nurs (2002) 34:228–36.10.1097/01376517-200210000-00002 [PubMed] [Cross Ref]
90. Simpson E, Carstensen J, Murphy P. Neonatal circumcision: new recommendations & implications for practiceMo Med (2014) 111:222–30.  [PubMed]
91. Sinkey RG, Eschenbacher MA, Walsh PM, Doerger RG, Lambers DS, Sibai BM, et al. The GoMo study: a randomized clinical trial assessing neonatal pain with Gomco vs Mogen clamp circumcisionAm J Obstet Gynecol (2015) 212:664.e1–8.10.1016/j.ajog.2015.03.029  [PubMed] [Cross Ref]
92. Frisch M, Earp BD. Circumcision of male infants and children as a public health measure in developed countries: a critical assessment of recent evidenceGlob Public Health (2016) 19:1–16.10.1080/17441692.2016.1184292  [PubMed] [Cross Ref]
93. Ben Chaim J, Livne PM, Binyamini J, Hardak B, Ben-Meir D, Mor Y. Complications of circumcision in Israel: a one year multicenter surveyIsr Med Assoc J (2005) 7:368–70.  [PubMed]
94. Gellis SS. CircumcisionAm J Dis Child (1978) 132:1168–9.  [PubMed]
95. Walker SM, Fitzgerald M, Hathway GJ. Surgical injury in the neonatal rat alters the adult pattern of descending modulation from the rostroventral medullaAnesthesiology (2015) 122:1391–400.10.1097/ALN.0000000000000658 [PMC free article]  [PubMed] [Cross Ref]
96. Van der Velde L, Curran AK, Filiano JJ, Darnall RA, Bartlett D, Jr, Leiter JC. Prolongation of the laryngeal chemoreflex after inhibition of the rostral ventral medulla in piglets: a role in SIDS? J Appl Physiol (2003) 94:1883–95.10.1152/japplphysiol.01103.2002  [PubMed] [Cross Ref]
97. Massey CA, Kim G, Corcoran AE, Haynes RL, Paterson DS, Cummings KJ, et al. Development of brainstem 5-HT1a receptor-binding sites in serotonin-deficient miceJ Neurochem (2013) 126:749–57.10.1111/jnc.12311 [PMC free article]  [PubMed] [Cross Ref]
98. Machaalani R, Waters KA. Neurochemical abnormalities in the brainstem of the Sudden Infant Death Syndrome (SIDS)Paediatr Respir Rev (2014) 15:293–300.10.1016/j.prrv.2014.09.008  [PubMed][Cross Ref]
99. Kinney HC, Richerson GB, Dymecki SM, Darnall RA, Nattie EE. The brainstem and serotonin in the sudden infant death syndromeAnnu Rev Pathol (2009) 4:517.10.1146/annurev.pathol.4.110807.092322 [PMC free article]  [PubMed] [Cross Ref]
100. Kinney HC, Thach BT. The sudden infant death syndromeN Engl J Med (2009) 361:795–805.10.1056/NEJMra0803836 [PMC free article]  [PubMed] [Cross Ref]
101. Decima PF, Fyfe KL, Odoi A, Wong FY, Horne RS. The longitudinal effects of persistent periodic breathing on cerebral oxygenation in preterm infantsSleep Med (2015) 16:729–35.10.1016/j.sleep.2015.02.537  [PubMed] [Cross Ref]
102. Watanabe S, Kuwaki T, Yanagisawa M, Fukuda Y, Shimoyama M. Persistent pain and stress activate pain-inhibitory orexin pathwaysNeuroreport (2005) 16:5–8.10.1097/00001756-200501190-00002 [PubMed] [Cross Ref]
103. Shahid IZ, Rahman AA, Pilowsky PM. Orexin A in rat rostral ventrolateral medulla is pressor, sympatho-excitatory, increases barosensitivity and attenuates the somato-sympathetic reflexBr J Pharmacol (2012) 165:2292–303.10.1111/j.1476-5381.2011.01694.x [PMC free article]  [PubMed][Cross Ref]
104. Hunt NJ, Waters KA, Rodriguez ML, Machaalani R. Decreased orexin (hypocretin) immunoreactivity in the hypothalamus and pontine nuclei in sudden infant death syndromeActa Neuropathol (2015) 130:185–98.10.1007/s00401-015-1437-9  [PubMed] [Cross Ref]
105. Sisson TRC, Whalen LE, Telek A. The blood volume of infantsJ Pediatr (1959) 55:430–46.10.1016/S0022-3476(59)80084-6  [PubMed] [Cross Ref]
106. Kaplan GW. Complications of circumcisionUrol Clin North Am (1983) 10:543–9.  [PubMed]
107. Martin JA, Hamilton BE, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2013Natl Vital Stat Rep (2015) 64:1–65.  [PubMed]
108. Walter LM, Yiallourou SR, Vlahandonis A, Sands SA, Johnson CA, Nixon GM, et al. Impaired blood pressure control in children with obstructive sleep apneaSleep Med (2013) 14:858–66.10.1016/j.sleep.2013.01.015  [PubMed] [Cross Ref]
109. Kahn A, Groswasser J, Franco P, Scaillet S, Sawaguchi T, Kelmanson I, et al. Sudden infant deaths: stress, arousal and SIDSEarly Hum Dev (2003) 75(Suppl):147–66.10.1016/j.earlhumdev.2003.08.018 [PubMed] [Cross Ref]
110. Thach BT. The role of respiratory control disorders in SIDSRespir Physiol Neurobiol (2005) 149:343–53.10.1016/j.resp.2005.06.011  [PubMed] [Cross Ref]
111. Kato I, Groswasser J, Franco P, Scaillet S, Kelmanson I, Togari H, et al. Developmental characteristics of apnea in infants who succumb to sudden infant death syndromeAm J Respir Crit Care Med (2001) 164:1464–9.10.1164/ajrccm.164.8.2009001  [PubMed] [Cross Ref]
112. Bisogni S, Dini C, Olivini N, Ciofi D, Giusti F, Caprilli S, et al. Perception of venipuncture pain in children suffering from chronic diseasesBMC Res Notes (2014) 7:735.10.1186/1756-0500-7-735 [PMC free article]  [PubMed] [Cross Ref]
113. Na AF, Tanny SP, Hutson JM. Circumcision: is it worth it for 21st-century Australian boys? J Paediatr Child Health (2015) 51:580–3.10.1111/jpc.12825  [PubMed] [Cross Ref]
114. Darby R. Risks, benefits, complications and harms: neglected factors in the current debate on non-therapeutic circumcisionKennedy Inst Ethics J (2015) 25:1–34.10.1353/ken.2015.0004  [PubMed][Cross Ref]
115. American Academy of Pediatrics Task Force on Circumcision. Circumcision policy statementPediatrics (2012) 130:585–6.10.1542/peds.2012-1989  [PubMed] [Cross Ref]
116. Frisch M, Aigrain Y, Barauskas V, Bjarnason R, Boddy SA, Czauderna P, et al. Cultural bias in the AAP’s 2012 technical report and policy statement on male circumcisionPediatrics (2013) 131:796–800.10.1542/peds.2012-2896  [PubMed] [Cross Ref]
117. Taddio A, Shah V, Gilbert-MacLeod C, Katz J. Conditioning and hyperalgesia in newborns exposed to repeated heel lancesJAMA (2002) 288:857–61.10.1001/jama.288.7.857  [PubMed] [Cross Ref]
118. Hartley C, Goksan S, Poorun R, Brotherhood K, Mellado GS, Moultrie F, et al. The relationship between nociceptive brain activity, spinal reflex withdrawal and behaviour in newborn infantsSci Rep(2015) 5:1–13.10.1038/srep12519 [PMC free article]  [PubMed] [Cross Ref]
119. Goksan S, Hartley C, Emery F, Cockrill N, Poorun R, Moultrie F, et al. fMRI reveals neural activity overlap between adult and infant painElife (2015) 4:e06356.10.7554/eLife.06356 [PMC free article][PubMed] [Cross Ref]
120. Fabrizi L, Slater R, Worley A, Meek J, Boyd S, Olhede S, et al. A shift in sensory processing that enables the developing human brain to discriminate touch from painCurr Biol (2011) 21:1552–8.10.1016/j.cub.2011.08.010 [PMC free article]  [PubMed] [Cross Ref]
121. Brummelte S, Grunau RE, Chau V, Poskitt KJ, Brant R, Vinall J, et al. Procedural pain and brain development in premature newbornsAnn Neurol (2012) 71:385–96.10.1002/ana.22267 [PMC free article][PubMed] [Cross Ref]
122. Blackwell C, Moscovis S, Hall S, Burns C, Scott RJ. Exploring the risk factors for sudden infant deaths and their role in inflammatory responses to infectionFront Immunol (2015) 6:44.10.3389/fimmu.2015.00044 [PMC free article]  [PubMed] [Cross Ref]
123. Ferrante L, Opdal SH. Sudden infant death syndrome and the genetics of inflammationFront Immunol (2015) 6:63.10.3389/fimmu.2015.00063 [PMC free article]  [PubMed] [Cross Ref]
124. Arnestad M, Andersen M, Vege A, Rognum TO. Changes in the epidemiological pattern of sudden infant death syndrome in southeast Norway, 1984–1998: implications for future prevention and researchArch Dis Child (2001) 85:108–15.10.1136/adc.85.2.108 [PMC free article]  [PubMed] [Cross Ref]
125. Mage DT, Donner EM. Is excess male infant mortality from sudden infant death syndrome and other respiratory diseases X-linked? Acta Paediatr (2013) 103:188–93.10.1111/apa.12482  [PubMed] [Cross Ref]
126. Guntheroth WG. Crib Death: The Sudden Infant Death Syndrome. 3rd ed Armonk, New York: Futura Publishing Co; (1995).
127. Waaijenborg S, Hahné SJ, Mollema L, Smits GP, Berbers GA, van der Klis FR, et al. Waning of maternal antibodies against measles, mumps, rubella, and varicella in communities with contrasting vaccination coverageJ Infect Dis (2013) 208:10–6.10.1093/infdis/jit143 [PMC free article]  [PubMed][Cross Ref]
128. Ferrante L, Rognum TO, Vege Ã…, NygÃ¥rd S, Opdal SH. Altered gene expression and possible immunodeficiency in cases of sudden infant death syndromePediatr Res (2016) 80:77–84.10.1038/pr.2016.45  [PubMed] [Cross Ref]
129. Horne RS, Nixon GM. The role of physiological studies and apnoea monitoring in infantsPaediatr Respir Rev (2014) 15:312–8.10.1016/j.prrv.2014.09.007  [PubMed] [Cross Ref]
130. Prabhakar NR, Peng YJ, Kumar GK, Nanduri J. Peripheral chemoreception and arterial pressure responses to intermittent hypoxiaCompr Physiol (2015) 5:561–77.10.1002/cphy.c140039 [PMC free article]  [PubMed] [Cross Ref]
131. Indic P, Paydarfar D, Barbieri R. Point process modeling of interbreath interval: a new approach for the assessment of instability of breathing in neonatesIEEE Trans Biomed Eng (2013) 60:2858–66.10.1109/TBME.2013.2264162 [PMC free article]  [PubMed] [Cross Ref]
132. Chung SA, Yuan H, Chung F. A systemic review of obstructive sleep apnea and its implications for anesthesiologistsAnesth Analg (2008) 107:1543–63.10.1213/ane.0b013e318187c83a  [PubMed][Cross Ref]
133. Chouchou F, Khoury S, Chauny JM, Denis R, Lavigne GJ. Postoperative sleep disruptions: a potential catalyst of acute pain? Sleep Med Rev (2014) 18:273–82.10.1016/j.smrv.2013.07.002  [PubMed][Cross Ref]
134. Hakim F, Gozal D, Kheirandish-Gozal L. Sympathetic and catecholaminergic alterations in sleep apnea with particular emphasis on childrenFront Neurol (2012) 3:7.10.3389/fneur.2012.00007 [PMC free article]  [PubMed] [Cross Ref]
135. Kang KT, Chiu SN, Weng WC, Lee PL, Hsu WC. Analysis of 24-hour ambulatory blood pressure monitoring in children with obstructive sleep apnea: a hospital-based studyMedicine, Balt (2015) 94:e1568.10.1097/MD.0000000000001568 [PMC free article]  [PubMed] [Cross Ref]
136. McSharry DG, Saboisky JP, Deyoung P, Jordan AS, Trinder J, Smales E, et al. Physiological mechanisms of upper airway hypotonia during REM sleepSleep (2014) 37:561–9.10.5665/sleep.3498 [PMC free article]  [PubMed] [Cross Ref]
137. Dalmases M, Torres M, Márquez-Kisinousky L, Almendros I, Planas AM, Embid C, et al. Brain tissue hypoxia and oxidative stress induced by obstructive apneas is different in young and aged ratsSleep(2014) 37:1249–56.10.5665/sleep.3848 [PMC free article]  [PubMed] [Cross Ref]
138. Kato I, Franco P, Groswasser J, Scaillet S, Kelmanson I, Togari H, et al. Incomplete arousal processes in infants who were victims of sudden deathAm J Respir Crit Care Med (2003) 168:1298–303.10.1164/rccm.200301-134OC  [PubMed] [Cross Ref]
139. Longin E, Dimitriadis C, Shazi S, Gerstner T, Lenz T, König S. Autonomic nervous system function in infants and adolescents: impact of autonomic tests on heart rate variabilityPediatr Cardiol (2009) 30:311–24.10.1007/s00246-008-9327-8  [PubMed] [Cross Ref]
140. Schechtman VL, Raetz SL, Harper RK, Garfinkel A, Wilson AJ, Southall DP, et al. Dynamic analysis of cardiac R-R intervals in normal infants and in infants who subsequently succumbed to the sudden infant death syndromePediatr Res (1992) 31:606–12.10.1203/00006450-199206000-00014  [PubMed][Cross Ref]
141. Schechtman VL, Henslee JA, Harper RM. Developmental patterns of heart rate and variability in infants with persistent apnea of infancyEarly Hum Dev (1998) 50:251–62.10.1016/S0378-3732(97)00047-7  [PubMed] [Cross Ref]
142. Eyre EL, Duncan MJ, Birch SL, Fisher JP. The influence of age and weight status on cardiac autonomic control in healthy children: a reviewAuton Neurosci (2014) 186:8–21.10.1016/j.autneu.2014.09.019  [PubMed] [Cross Ref]
143. Fernández-Agüera MC, Gao L, González-Rodríguez P, Pintado CO, Arias-Mayenco I, García-Flores P, et al. Oxygen sensing by arterial chemoreceptors depends on mitochondrial complex I signalingCell Metab (2015) 22:825–37.10.1016/j.cmet.2015.09.004  [PubMed] [Cross Ref]
144. Sunday ME. Oxygen, gastrin-releasing peptide, and pediatric lung disease: life in the balanceFront Pediatr (2014) 2:72.10.3389/fped.2014.00072 [PMC free article]  [PubMed] [Cross Ref]
145. Cutz E. Hyperplasia of pulmonary neuroendocrine cells in infancy and childhoodSemin Diagn Pathol (2015) 32:420–37.10.1053/j.semdp.2015.08.001  [PubMed] [Cross Ref]
146. Elliot J, Vullermin P, Carroll N, James A, Robinson P. Increased airway smooth muscle in sudden infant death syndromeAm J Respir Crit Care Med (1999) 160:313–6.10.1164/ajrccm.160.1.9802024 [PubMed] [Cross Ref]
147. Krous HF, Haas E, Hampton CF, Chadwick AE, Stanley C, Langston C. Pulmonary arterial medial smooth muscle thickness in sudden infant death syndrome: an analysis of subsets of 73 casesForensic Sci Med Pathol (2009) 5:261–8.10.1007/s12024-009-9116-6 [PMC free article]  [PubMed] [Cross Ref]
148. Wilders R. Cardiac ion channelopathies and the sudden infant death syndromeISRN Cardiol (2012) 2012:1–28.10.5402/2012/846171 [PMC free article]  [PubMed] [Cross Ref]
149. Tester DJ, Ackerman MJ. Sudden infant death syndrome: how significant are the cardiac channelopathies? Cardiovasc Res (2005) 67:388–96.10.1016/j.cardiores.2005.02.013  [PubMed][Cross Ref]
150. Neary MT, Breckenridge RA. Hypoxia at the heart of sudden infant death syndrome? Pediatr Res(2013) 74:375–9.10.1038/pr.2013.122 [PMC free article]  [PubMed] [Cross Ref]
151. Perticone F, Ceravolo R, Maio R, Cosco C, Mattioli PL. Heart rate variability and sudden infant death syndromePacing Clin Electrophysiol (1990) 13:2096–9.10.1111/j.1540-8159.1990.tb06949.x  [PubMed][Cross Ref]
152. Evans A, Bagnall RD, Duflou J, Semsarian C. Postmortem review and genetic analysis in sudden infant death syndrome: an 11-year reviewHum Pathol (2013) 44:1730–6.10.1016/j.humpath.2013.01.024 [PubMed] [Cross Ref]
153. Santori M, Blanco-Verea A, Gil R, Cortis J, Becker K, Schneider PM, et al. Broad-based molecular autopsy: a potential tool to investigate the involvement of subtle cardiac conditions in sudden unexpected death in infancy and early childhoodArch Dis Child (2015) 100:952–6.10.1136/archdischild-2015-308200 [PubMed] [Cross Ref]
154. Van Norstrand DW, Ackerman MJ. Sudden infant death syndrome: do ion channels play a role? Heart Rhythm (2009) 6:272–8.10.1016/j.hrthm.2008.07.028 [PMC free article]  [PubMed] [Cross Ref]
155. Methner DN, Scherer SE, Welch K, Walkiewicz M, Eng CM, Belmont JW, et al. Postmortem genetic screening for the identification, verification, and reporting of genetic variants contributing to the sudden death of the youngGenome Res (2016) 26:1170–7.10.1101/gr.195800.115 [PMC free article]  [PubMed][Cross Ref]
156. McEwen BS. Stress, adaptation, and disease. Allostasis and allostatic loadAnn N Y Acad Sci (1998) 840:33–44.10.1111/j.1749-6632.1998.tb09546.x  [PubMed] [Cross Ref]
157. Berger M, Juster RP, Sarnyai Z. Mental health consequences of stress and trauma: allostatic load markers for practice and policy with a focus on Indigenous healthAustralas Psychiatry (2015) 23:644–9.10.1177/1039856215608281  [PubMed] [Cross Ref]
158. Elhaik E, Zandi P. Dysregulation of the NF-κB pathway as a potential inducer of bipolar disorderJ Psychiatr Res (2015) 70:18–27.10.1016/j.jpsychires.2015.08.009  [PubMed] [Cross Ref]
159. Christiaens I, Hegadoren K, Olson DM. Adverse childhood experiences are associated with spontaneous preterm birth: a case-control studyBMC Med (2015) 13:124.10.1186/s12916-015-0353-0 [PMC free article]  [PubMed] [Cross Ref]
160. Juster RP, McEwen BS, Lupien SJ. Allostatic load biomarkers of chronic stress and impact on health and cognitionNeurosci Biobehav Rev (2010) 35:2–16.10.1016/j.neubiorev.2009.10.002  [PubMed][Cross Ref]
161. Carpenter R, McGarvey C, Mitchell EA, Tappin DM, Vennemann MM, Smuk M, et al. Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case–control studiesBMJ Open (2013) 3:e002299.10.1136/bmjopen-2012-002299 [PMC free article]  [PubMed][Cross Ref]
162. Emery J. A way of looking at the causes of crib death. In: Tildon J, Roeder L, Steinschneider A, editors. , editors. Proceedings of the International Research Conference on the Sudden Infant Death Syndrome New York: Academic Press (1983). p. 123–32.
163. Filiano J, Kinney H. A perspective on neuropathologic findings in victims of the sudden infant death syndrome: the triple-risk modelBiol Neonate (1994) 65:194–7.10.1159/000244052  [PubMed] [Cross Ref]
164. Cold CJ, Taylor JR. The prepuceBr J Urol (1999) 83:34–44.10.1046/j.1464-410x.1999.0830s1034.x [Cross Ref]
165. Shapiro-Mendoza CK, Camperlengo LT, Kim SY, Covington T. The sudden unexpected infant death case registry: a method to improve surveillancePediatrics (2012) 129:e486–93.10.1542/peds.2011-0854 [PubMed] [Cross Ref]
166. Elhaik E, Tatarinova T, Chebotarev D, Piras IS, Maria Calò C, De Montis A, et al. Geographic population structure analysis of worldwide human populations infers their biogeographical originsNat Commun (2014) 5.10.1038/ncomms4513 [PMC free article]  [PubMed] [Cross Ref]
167. Risser JM, Risser WL, Eissa MA, Cromwell PF, Barratt MS, Bortot A. Self-assessment of circumcision status by adolescentsAm J Epidemiol (2004) 159:1095–7.10.1093/aje/kwh149  [PubMed][Cross Ref]
168. Mulongo P, Hollins Martin C, McAndrew S. The psychological impact of Female Genital Mutilation/Cutting (FGM/C) on girls/women’s mental health: a narrative literature reviewJ Reprod Infant Psychol (2014) 32:1–17.10.1080/02646838.2014.949641 [Cross Ref]
169. Saraçoglu M, Öztürk H. Female circumcisionAndrol Gynecol Curr Res (2014) 2:1–3.10.4172/2327-4360.1000120 [Cross Ref]
170. Warnock F, Sandrin D. Comprehensive description of newborn distress behavior in response to acute pain (newborn male circumcision)Pain (2004) 107:242–55.10.1016/j.pain.2003.11.006  [PubMed][Cross Ref]

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