Failure to thrive and fading puppy Flashcards
Immediate care of the neonate
Always check
- airway
– if necessary remove membranes, dry with towel, aspirate fluid
- breathing
– if necessary rub chest, apply positive pressure ventilation
- circulation
– if necessary external cardiac massage
If necessary clamp and cut umbilicus (at 3cm)
Dry the pup and place in a warm nest
Encourage the pup to suck
Then:
- record birth weight (should gain 5-10% BW/day, failure to do so may indicate dz)
- monitor resp (15-40brpm)
- record temp: often considered unnecessary but really helpful (34C)
- check for congenital abnormalities, such as cleft palate or harelip
Care of the neonate (birth to 2w/o) - why is the neonate different to the adult? What do these factors result in?
Why is the neonate different to the adult?
- poor breathing
- limited ability to regulate body temp
- poor regulation of fluid balance
- limited energy store
- immune system is immature
All of these factors result in:
- increased susceptibility to dz
- poor response to dz (rapid hypothermia, rapid fluid loss, energy depletion and poor immunological response)
- potential for high mortality rate
Care of the neonate (birth to 2w/o) - key aspects of ongoing care
- ensuring colostrum and milk intake
- ensuring hydration status
- monitoring environmental temperature and pup behaviour
- regular CE
Care of the neonate (birth to 2w/o) - ensuring colostrum & milk intake
- essential to have adequate intake within the 1st 48h
- neonates should suck every 2-4h
- problems: weak pups, insufficient teats (large litters), inexperienced/difficult dam, continual disturbance by humans
- monitor pup weight gain
- have alternate food sources available
Care of the neonate (birth to 2w/o) - ensuring hydration status
Simplest method is to evaluate urine colour
- normally urine is colourless
Other signs (but these may occur later)
- dry mm
- slow CRT
- skin tenting
Care of the neonate (birth to 2w/o) - monitoring temp
Ideal environmental temperature for neonatal pups:
- 28-30C for 1st wk
- 26C for next 3-4w
Monitor temp of pups?
Evaluate behaviour of pups (huddled/spread out)
Care of the neonate (birth to 2w/o) - regular CE
In general, a neonate should double its weight in 8-10d
Signs of a sick pup
- frequent crying or failure to gain weight early indicator
- cold to touch
- skin inelastic
- thin, bony appearance
- slack abdomen (empty stomach)
- dirty unkempt coat
- persistent crying
- loss of body twitching
- delayed development of neonatal characteristics
Neonatal characteristics
- pups unable to stand at birth but use limbs to crawl
- strength gradually increases and standing seen from d10, most pups walk at 3w
- eyes open 10-14d after birth, cornea may appear slightly cloudy at 1st
- voluntary defecation/urination after wk2 or 3
Tx of the sick puppy - minor dz
- any neonate with minor signs of dz (lethargy, slow to feed, lack of weight gain) should have early supplemental feeding
- if concern over intake of colostrum, a source of frozen-thawed or replacement colostrum should be given before d3
- if necessary use tube feeding
- maintain body temp, which should be recorded every few hours
- environmental temp should also be monitored using a thermometer placed adjacent to the neonates
- adequate hydration should be ensured and can be estimated from:
– urine examination: normal is colourless, and the presence of colour in the urine may be a useful & simple indicator of dehydration - general nursing care is important and should include regular perineal stimulation to ensure urine and faecal voiding
- antimicrobials may be considered
– not because there is a primary bacterial infection
– but the neonate is susceptible to commensal overgrowth - oral amoxy-clav at 12.5-25mg/kg twice daily
- hypothermia causes ileus causing bacterial infection by commensal overgrowth
Colostrum
- 60% absorption before 4h, 5% after 12h
- experimentally colostrum deprived pups given hyperimmune serum SC twice within 8h of birth showed no difference in IgG to pups that had no supplement
- the only real solution is to have frozen colostrum available
- recently launched Royal Canine product: ‘Puppy pro tech’
Tx of the sick puppy - significant dz
Onset of downward spiral of failure to suck resulting ultimately in circulatory collapse and death
Worsened/complicated by:
- hypothermia -> ileus -> bloated abdomen
- hypoxia -> resp distress
- hypothermia -> bacterial overgrowth
^ all result in failure to suck -> hypoglycaemia & dehydration which causes hypothermia
i.e. downward spiral
Absence of feeding, dehydration or other CS necessitate immediate aggressive tx
- reverse hypothermia
- rever hypoxia
- tx/prevent dehydration
- prevent commensal organism overgrowth
Despite tx mortality rate can be high
Rigorous CE done q4h to include:
- rectal temp
- urine colour and skin elasticity
- mm colour and CRT
- rr & hr
Hypothermia
- slow re-heating (1C per hr)
- maintain environmental temp 29-32C (slightly higher than normal)
- don’t feed pup if colder than 34C
- add dextrose to fluids (as increased calorific demand)
Oxygen
- incubator or use homemade oxygen tent
- alternatively, a tracheal catheter may be placed
- esp useful for pups with concomitant URT problems
- oxygen can help overcome hypoxia and artificial ventilation may be useful to reverse acidosis and encourage lung surfactant production
Fluid therapy
- pups with pale and dry mm and slow CRT are usually at least 10% dehydrated
- this deficit needs to be replaced along with the ongoing maintenance requirement
- fluid requirements for general maintenance are approx 60-100ml/kg/day
Predictors of mortality
- low APGAR score (less than 6)
– hr, rr, response, mobility, mm colour - dehydration (urine is coloured)
- no increase (worse = decrease) in BW
- rectal temp less than 35C
- plasma glucose less than 100mg/dl
- worse is low glucose and low temp = 67% mortality
- umbilical lactate [] above 5mmol/l
- IgG less than 3g/L = 35% mortality
2w-6w old - most life threatening problems
- dehydration from d+
- internal and external parasites
- traumatic insults
2w-6w old - other conditions may become apparent in this periods
- congenital defects such as megaoesophagus as change from liquid to solid food
- juvenile hypoglycaemia (immature hepatic enzymes - failure to adapt to fasting between meals i.e. seen after weaning) in some breeds
- fatty liver syndrome in some breeds may be evidence as failure to thrive
2w-6w old - best predictors of wellness
- continued growth
- normal behavioural development (walking, exploration, interaction)
- normal rectal temp
6w-12w old - what happens during this period
- more similar to adult physiology but have increased maintenance requirements for calories and water
- maternal antibodies start to be lost during this period so increased susceptibility to infectious dz
6w-12w old - most life threatening problems
- infectious dz
- dz associated with inquisitive behaviour (FB, biting electric cables)
6w-12w old - many cases of failure to thrive
- poor nutrition
- poor energy absorption (e.g. GI dz, always consider parasitism)
- poor energy conversion (e.g. porto-systemic shunt)
- within, or after, this period metabolic dz may become apparent
– hypoglycaemia (substrate-limited hypoglycaemia)
6w-12w old - common presenting signs
- failure to gain weight
- neuro signs
– for fitting always consider hypoglycaemia 1st
– porto-systemic shunt
– hydrocephalus
6w-12w old - within, or after, this period other metabolic disease may become apparent, such as…
- pituitary dwarfism
- features & problems of chondrodysplastic breeds become apparent
- congenital hypothyroidism
- juvenile DI
- juvenile DM
- juvenile onset hyperadrenocorticism
- juvenile hyperparathyroidism
What are the causes of fading puppies?
28% are actually sick at birth
- management & maternal causes (16%)
- very low BW (7%)
- congenital defects (5%) (often fade and die before d3
55% appear normal a birth but may have inadequate surfactant
- fade and die between d3-5
- find it difficult to suck
- hyperthermic & hypoglycaemic
15% appear normal at birth but succumb to infection
- often fade and die after d6
True fading puppies
It took time for the role of surfactant in puppy losses to become apparent, and these cases initially seemed mysterious - often referred to as pups which fade without case or ‘true fading puppies
- normal birth weight, but lose weight quickly
- fade and die between d3-5
- strong tendency for certain dams to have successive fading litters
- non-infective
Immature vs mature lungs
Immature
- low surfactant levels
- not conducive to gas exchange
- thick blood gas barrier
- low compliance
- immature epithelial cells
- small area for gas exchange
- poorly vascularised
- high resistance to blood flow
Mature
- adequate surfactant
- conducive to gas exchange
- thin blood gas barrier
- highly compliant
- mature epithelial cells
- large area for gas exchange
- highly vascular
- low resistance to blood flow
The role of lung surfactant in true fading puppies
- poor resp function
- resp distress
- inability to suck
- fatal cycle of hypoxia, dehydration, low blood sugars, hypothermia and death
Tx of fading pups
Tx spoken about above with minor and significant dz
Interesting point:
- pups born by c-section have significantly lower surfactant [] cf vaginal birth
Anecdotally:
- pre-surgery methylprednisolone 0.5, 1 or 2mg/kg or dexamethasone preferably 24-48h and at least 1h pre-surgery may improve surfactant in pups
Administration of progesterone receptor antagonist (aglepristone/Alizin) 24h prior to c-section may improve surfactant levels in pups subsequently delivered
