Dear Ms. Reese,

Regarding our article titled "Newborn behavioral and physiological responses to circumcision after administration of preoperative analgesia" published in 2003 in MCN, The American Journal of Maternal/Child Nursing, my first comment is that the data for this study were collected before 1999. We felt strongly that the results we found between the groups were important enough that we needed to publish this article. The study was conducted before the Joint Commission on Accreditation of Healthcare Organizations' (JACHO) recommendations about pain were published (1999). Therefore, the "customary policy" at the time the data were collected was NOT yet developed to assess, treat, and document pain in the newborn, nor had the AAP Circumcision Policy Statement (1999) been published. In addition, the study was conducted with newborns whose physicians did not routinely provide anesthesia or analgesia for the circumcision procedure, so no treatments that were routinely ordered for pain were withheld.

Another criticism you made was that the sample "was not even large enough to provide statistical differences between groups." We could have provided the t-tests and p values that demonstrated the factors that were significant, but power analysis wasn't routinely done at the time this study was conducted. We could have reported a post hoc power analysis but did not feel it would add to the meaning.

I do hope the clarification about when the data were collected will relieve the writer's concerns over unethical conduct of research. Two of the authors, Ms. Malnory and Dr. Johnson, have served as strong advocates in several institutions for standard pain relief measures for newborns, in addition to the ethical conduct of research for all study subjects.

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