TOPLINE:

Pain in neonates after circumcision decreased significantly after the implementation of a comprehensive nurse practitioner (NP)-led management.

METHODOLOGY:

• Researchers evaluated the effectiveness of an NP-led evidence-based protocol for managing pain in newborn boys (gestation age ≥ 35 weeks) undergoing circumcision from the preprocedural to recovery period, which was implemented at a large academic public level 1 trauma center on July 29, 2024.
• The protocol included acetaminophen administration 30 minutes pre-procedure, white noise utilization during circumcision, standardized pain assessment documentation post-procedure, and interventions (including a second dose of acetaminophen and nonpharmacologic methods) during the recovery period.
• The project used a quality improvement design guided by the Knowledge-to-Action framework and Plan-Do-Study-Act cycles.
• The primary outcome was a reduction in neonatal pain, measured using the Neonatal Pain, Agitation, and Sedation Scale; the secondary outcome was NP or nurse compliance with the new protocol changes.

TAKEAWAY:

• Neonatal pain scores significantly decreased from a mean of 3.14 to 1.12 after Plan-Do-Study-Act cycle 6 of the NP-led protocol (P < .001).
• The initial audit revealed that only 4.7% of circumcised neonates received a second dose of acetaminophen, and 6.3% received a nonpharmacologic intervention.
• All protocol aims were achieved by cycle 3 and maintained through cycle 6, with 100% of providers agreeing that the new protocol improved neonatal pain management.
• Pre-implementation data showed that 70% of neonates had pain scores ≥ 3, highlighting the need for intervention.

IN PRACTICE:

“This NP-led EBPQI [evidence-based practice quality improvement] initiative can guide health care providers to improve pain in circumcised newborns, with potential for addressing other clinical problems within practice settings,” the authors wrote, adding that “this NP-led initiative underscores the critical need for further exploration of effective pain management in circumcised newborns, particularly in the absence of universal guidelines.”

SOURCE:

This study was led by Renu Mathews Philip, DNP, APRN, CPNP, EBP-C, Parkland Health, Plano, Texas. It was published online on December 3, 2025, in the Journal of Pediatric Health Care.

LIMITATIONS:

The initiative was conducted at a single site, which limited generalizability. Although pain scores immediately post-circumcision showed improvement, the researchers did not collect or analyze pain scores during the recovery period.

DISCLOSURES:

No funding information was provided for the study. The authors declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.