Postoperative Care
The postoperative care of the circumcised penis is a simple, but extremely important part of the overall care in neonatal circumcisions. Proper postoperative care diminishes the complications of pain, parental worries about infection, allows for proper healing, and prevents postoperative complications like preputial adhesions formation, and skin bands (see section Common Pitfalls and Problems > Preputial adhesions and skin bands).
Elements of Good Postoperative Care
The nurse checks the circumcised penis every 15 minutes for the first two hours to assess for excessive bleeding.
Every diaper change must have white petrolatum ("Vaseline") on the front of the diaper to prevent the exposed glans from adhering ("sticking") to the diaper and causing bleeding or painful removal of healing serous exudate on the glans penis. The white petrolatum can be stopped when there is full epithelialization with cornified squamous epithelium in about seven days.
With each diaper change, the parent should gently retract the preputial remnant off the glans until there is full epithelialization. Otherwise, they risk formation of preputial adhesions or a fibrous skin band.
Postoperative pain may be necessary for the first day or two. Use acetaminophen, 15mg/kg/dose, or usually about 40mg (0.4ml of infant drops). Warn parents not to give more than three to four doses per day, and for only one to two days. There is a risk to infer, on the part of the parent, that all infant crying is from post-operative pain and parents can inadvertently overdose the neonate.
Advise parents that normal healing of the glans penis involves a yellowish, crusty, serous exudate that aids in epitheialization. This should not be misinterpreted as pus (an opaque yellow-white or yellow-green purulent exudate) from an infection.
Cleaning of the glans penis can be done with warm soapy tap water, without painful scrubbing that may disrupt the serous exudate. Avoid painful alcohol or alcohol-based diaper wipes to the healing area.