In natural settings, infants are often subject to colonization at birth with the aerobic and anaerobic flora of their mothers; they also receive specific immunoglobin across the placenta before delivery and, later, through ingestion of breast milk. In contrast, babies born and cared for in hospital tend to be colonized by E. coli acquired from the environment....

On the basis of these observations, Winberg and collaborators (47) suggested two alternative preventive strategies [alternatives to circumcision, against urinary tract infection (UTI)]: deliberate colonization with nonpathogenic bacterial flora [i.e., colonization with mother’s protective “good germs”] during the newborn period or the promotion of rooming-in to facilitate close contact between newborns and their mother [to foster the same protection acquired from mother, as above]. The first strategy is analogous to the active colonization of the umbilicus and nasal mucosa undertaken in the past to arrest epidemics of infection with Staphylococcus aureus.

These two strategies need to be evaluated further. One would expect both to have a low risk of complications. The second is in keeping with recent trends in maternal and infant care and could have a low cost. If either strategy is successful, it may prove to be a more cost-efficient way to prevent UTI among male infants than circumcision. Such an approach could also be applied to the prevention of UTI in female infants, since adherence of bacteria to epithelial cells also plays a role in the development of UTI in girls.

There has been one report of a case-control study of breast-feeding and UTI among infants(49). In the study, 47% of 62 infants presenting with a UTI had been breast-fed, whereas 82% of 62 control infants [that is, infants not having a UTI] seen at a well-baby clinic and 87% of 62 control infants [that is, not having a UTI] admitted to hospital because of fever had been breast-fed, and none of the control infants had a UTI (p < 0.001)....

(47) Winberg J, Bollgren I, Gothefors L et al: The prepuce: a mistake of nature? Lancet 1989; 1: 598-599.

(49) Piscane A, Graziano L, Zona G: Breast feeding and urinary tract infection. [letter] Lancet 1990; 336: 50.

— Fetus and Newborn Committee, Canadian Paediatric Society. “Neonatal Circumcision Revisited.” Canadian Medical Association Journal,154 (6), March 15, 1996, pp. 769-780.

• What are the risks of UTI in circumcised and intact infants? A physician reviews the scientific evidence.