Canine and Feline Neonatology Flashcards
1
Q
What are four of the main causes of neonatal death?
A
- Hypothermia
- Hypoglycemia
- Hypoxia
- Hypovolemia
2
Q
Neonate age range
A
birth to 2 weeks
3
Q
Pediatric/infant age range
A
2 weeks to 8 weeks
4
Q
Juvenile age range
A
8 weeks to 6 months
5
Q
Adult
A
6 months +
6
Q
How long is dog pregnancy?
A
9 weeks
7
Q
Unique characteristics of puppies and kittens when born
A
- Blind
- Poikilothermic
- Limited mobility
- Entirely dependent on mother for survival
8
Q
How does blood pressure change from week 1 to week 4 of life?
A
- Low BP (50) to higher (~150?)
9
Q
How does heart rate change from week 1 to week 4 of life?
A
- Decreases (200 to ~100)
10
Q
Cardiovascular physiology of neonates (skipped in class so maybe don’t emphasize)
A
- Umbilical circulation occluded
- Close ductus venosus and ductus arteriosus
- Circulation redirected to lungs and liver due to changing pressures
- Increased circulation to kidneys, GIT, muscles
11
Q
How does anoxia affect the heart rate of puppies?
A
- Mild hypoxia doesn’t affect
- Anoxia before 4 days of age causes profound bradycardia (45 bpm) and marked hypotension (systolic pressure 23 mmHg)
12
Q
Heart rate response to vagal inhibition in puppies
A
- Parasympathetic structure appears mature but heart rate responds poorly to vagal inhibition in puppies under 2 weeks
- Poor or no response to atropine, so treat bradycardia with oxygen and warming
13
Q
First respirations in neonates?
A
- Inhibited in utero
- Respiration stimulated by hypoxia, hypercapnea, and cooling of the skin at birth
- Breathing must begin within 8-10 minutes if permanent brain damage and death is to be avoided
- Genital and umbilical stimulation induces reflex respiration
- First breath is most difficult
14
Q
Beginning breaths and pressure
A
- Viscid fluid in alveoli requires inspired pressure of -30 cm H2O
- Neonate can exert -60 cm H2O
- Expiration of first breath requires positive pressure of 40 cm H2O to empty the alveoli
- Normal breathing is present is present within 40 minutes with pressure 0-15 cm H2O
15
Q
Steps to take when a neonate is first born?
A
- Clear airways and use suction if needed
- Don’t sling newborn around in effort to expel fluids from airway
- Newborn puppies and kittens can be intubated with tiny Cole tubes, small feeding tubes, and Tom cat catheters
- Don’t overinflate
16
Q
What % fluid are newborns?
A
- 80% at birth
- Skin is permeable and weight lost during first 24 hours
- Dehydration can occur quickly
17
Q
How long must urination be stimulated reflexively?
A
- 2 weeks
18
Q
Renal function of neonates
A
- Functional immaturity for 8 weeks
- Low GFR, depressed reabsorption
- Exaggerated salt loss and low concentrating ability
- Low serum urea nitrogen and creatinine with elevated phosphorus
- neonatal renal blood flow is correlated with blood pressure and not responsive to RAAS until 6 weeks of age
19
Q
GI of neonates
A
- Sterile at birth
- Neutral pH with increased permeability up to 10 hours after birth
- Intestinal electrical activity limited before day 40 so contents move mostly due to pressure gradients
- Stomach and intestinal contraction will sotp if body temp less than 94 degrees F
20
Q
Why is it so important to warm up neonates before feeding them?
A
- Stomach and intestinal contraction including sphincter control stops if the body temperature is <94°F
21
Q
Musculoskeletal movement of puppies and kittens newborn (skipped in class)
A
- Puppies and kittens move reflexively soon following birth with a nuzzling response
- Flexor dominance present for first 4 days
- Extensor reflexes dominate from day 5 to 3 weeks
22
Q
Neonatal TPR***
A
- Rectal temperature of newborn is 97°
- HR >200 BPM
- RR 15-35 breaths per minute
- Hypothermia and hypoxia cause bradycardia
23
Q
What should you check first if a newborn is bradycardic?
A
- Temperature and oxygen status!
24
Q
Body weight of puppies and kittens at birth
A
- Puppies 100-700g
- Kittens 100g
25
Poor prognostic indicator based on kitten weight
- Kittens <90g
26
Normal weight loss in puppies and kittens after they are born
- Should lose weight during first 24 hours
27
Weight gain in puppies and kittens
- After losing weight in first 24 hours, should gain weight at 5-7% each day
- Puppy weight should double by about 1-2 weeks and kittens double by 2 weeks
28
Signs of a healthy puppy
- Strong and wiggly
| - Gentle handling and patience required
29
Signs of a sick puppy
- Cry for prolonged periods (>20 minutes)
- Weak, limp, cool neonates are in serious conditions
- Deterioration and death can occur very quickly
30
Factors affecting neonatal survival (skipped in class)
- Unhealthy mother, stressful delivery
- Drugs used during delivery
- Congenital abnormality
- Poor nutrition
- Infectious disease
- Environment (temperature, ventilation, sanitation, housing)
31
Mortality rate depending on time spent in Stage II labor
- <5 hours - 5.8% mortality
5-24 hrs - 13%
>24 hours - 90% mortality!!**
32
Things needed for preparation of action after birth
- Trained personnel
- Suction
- Dried towels
- Oxygen and intubation
- Hemostat, suture, disinfectant, scissors
- Warm, soft, absorbent post delivery box
33
APGAR score
- Activity
- Pulse
- Grimace
- Appearance
- Respiration
- Higher numbers are better
- Measure at 1, 2, and 60 min post partum
34
Activity score
- Flaccid (0)
- Some flexion (1)
- Active motion (2)
35
Pulse score
- 0 <180
- 1 180-220
- 2 >220
36
Grimace score
```
0 = absent
1 = grimace
2 = vigorous
```
37
Appearance
```
0 = cyanotic
1 = pale
2 = pink
```
38
Respiration score
0 = no crying, <6 bpm
1 = mild crying, 6-15 bpm
2 = crying >15 bpm
39
Excellent condition score
- Routine care
| - 7-10 points
40
Moderately depressed APGAR
- 4-6
| - Rub thorax, ventilate, O2
41
Severely depressed APGAR
- 0-3
| - As above (rub thorax, ventilate, O2) plus IO epinephrine
42
Maternal causes of neonatal death
- maternal neglect
- Immaturity/anxiety/cannibalism
- Mastitis
- Metritis
- Sub involution of placental sites
43
Preweaning mortality %
- Preweaning mortality is 10-20% with most deaths in the first week of life
44
The four hypos again
- Hypothermia
- Hypovolemia
- Hypoglycemia
- Hypoxia
45
Treatment for hypothermia
- Rewarm
- Place in incubator (warmth, oxygen, and humidity)
- recirculating water heating pads, suspended light
- Do not use electric heating pads, hot water bottles, or rice bags directly on puppies
- Rewarm over 1-3 hours
46
Goal temperature for rewarming a neonate
- 98°F
| - Mimicking febrile response
47
Hypovolemia treatment - when to give oral fluids?
- ONLY IF TEMPERATURE ABOVE 94°
| - If it's below, you will kill them as gastric and intestinal motility is diminished and aspiration pneumonia may occur
48
Rate and dose of fluids for neonatal hypovolemia
- Administer 1mL LRS +2.5 mL 10% dextrose per 30 g body weight IV or IO
- Repeat once every 15 minutes until rehydrated and urine production begins
49
Parenteral routes for neonatal fluids
- IV (jugular vein)
- IO (proximal tibia, greater trochanter of femur, or proximal humerus) - WATCH OUT FOR THE SCIATIC NERVE
- Use spinal needle or 22g hypodermic needle
50
Hypoglycemia treatment
- Administer 0.25 mL 10% dextrose per 30 g body weight by stomach tube if body temperature above 94°F
- Warmed orphan formula may be administered as supplement if puppy or kitten warm and strong
51
Hypoxia in neonates
- Sepsis, pneumonia, hypothermia
- Incubate at 40% oxygen
- Do not give for prolonged periods at high levels due to potential for development of vitreal fibroplasia
52
Drug options for neonates
- blood transfusion if anemic
- Serum if FPT or suggestion of it
- Clavamox or cephalosporins generally safe
- Amikacin if aminoglycoside is needed but watch hydration status due to nephrotoxicity potential
- Vitamin K1 in puppies for hypoprothrombinemia
- L-thyroxine is last ditch
53
Milk composition of the bitch
- Mostly fat (65%), then 23% protein and 12% lactose (sugars)
By calories
- varies by species
54
Hand raising puppies and kittens
- Feed via bottle or with feeding tube
- Feed 105-120 kcal/lb body weight
- Kittens 100-175 kcal/lb bwt daily
Feed every 2-4 hours for first three days then every 4-6 hours after
- Don't wake them up if they appear full
55
Tube feeding puppies
- Tip of nose to last rib
- Should pass easily
- 8 or 10 Fr so it's less likely to go into the airway
- want them to swallow
- make sure you prefill the tube
56
Clinical lab testing of puppies
- Hematocrit and TP (often won't be normal)
- CBC
- Glucose
- BUN
- ALP
- GGT (should increase with colostrum)
57
Post-mortem examination (skipped)
- May be only means to establish cause of death
58
What do a full gall bladder and empty stomach suggest in a newborn?
- Failure to receive colostrum
- Even with diagnostic lab submission about 50% of cases not determined
- Submit entire puppy or kitten
