Neonatal Care

Question 1

What are the 4 main physiologic reasons for neonatal death?

Answer 1

Hypothermia
Hypoxia
Hypoglycemia
Hypovolemia

10 to 20% of deaths occur in first week of life

Question 2

What is considered neonate?

Answer 2

Birth to 2 weeks

Question 3

What is considered pediatric/infant?

Answer 3

2 weeks to 8 weeks

Question 4

At birth puppies and kittens are:

Answer 4

Blind
Poikilothermic
Have limited mobility
Entirely dependent on mother for survival

Question 5

Cardiovascular

Physiology and Anatomy

Answer 5

Umbilical circulation is occluded
Closure of ductus venosus
Closure of ductus arteriosus
Circulation redirected to lungs and liver due to changes in pressure
Increased circulation to kidneys, GI tract, muscles

Question 6

Week 1 vs Week 4: Heart Rate and Blood Pressure

Answer 6

Week 1:
High HR (200+) low BP (50)

Week 4: Normalize HR (110) and BP (140)

Question 7

Cardiovascular System

Anoxia

Answer 7

Before 4 days of age can cause profound bradycardia and marked hypotension

Immature parsympathetic system => will NOT respond to atropine administration

Therefore treat with oxygen and warming

Question 8

First Breaths
Stimulation
Importance

Answer 8

Respiration stimulated by hypoxia, hypercapnia, and cooling of the skin

Breathing MUST occur within 8 to 10 minutes otherwise permanent brain damage and death can result

First breath is difficult to do but essential

Genital and umbilical stimulation induces respiration reflex

Question 9

First Breaths

Physiology

Answer 9

Viscid fluid in alveoli requires inspired pressure at -30 (puppy is at -60); must take a large inhale

Expiration of first breath requires postive pressure of 40 to empty alveoli (must exhale hard the first time)

Normal breathing should be reached 40 minutes

Question 10

First Breaths

Innervention

Answer 10

Can clear airways with suction

Could intubate and give a tiny puff of air; do not over inflate lungs, very fragile

Question 11

Puppies and Fluid Composition

Answer 11

Newborns are 80% fluid

Skin is permeable and weight loss will occur in the first 24 hours

Must monitor for dehydration; if peeing should be okay

Question 12

Renal Development

Answer 12

Nephron development continues until 3 weeks of age

Functionally immature for first 8 weeks of life; low GFR, salt loss, low concentration ability

Low BUN/Creatinine
Elevated Phosphorous

Renal blood flow correlated to BP; RAAS not active until 6 weeks of age

Question 13

Gastrointestinal Development

Answer 13

GI sterile at birth

Neutral pH and increased permeability up to 10 hours after birth

Stomach and intestinal contraction stops if body temperature is less than 94; can aspirate and die (keep temp >97)

Question 14

Neonatal TPR

Answer 14

T: 97
HR: 200 bpm
R: 15 to 35 bpm

Question 15

What can cause bradycardia in a neonate?

Answer 15

Hypothermia

Hypoxia

Question 16

Body Weight

Answer 16

Good thing to monitor to assess how they are progressing
Failure to thrive?

Remember weight is lost in the first 24 hours
Day 2: gain 5-7% each day

Puppy: double weight by 7-10 days
Kitten: double weight bey 14 days

Question 17

Factors Affecting Neonatal Survival

Answer 17

Unhealthy mother
Stressful delivery
Drugs used during delivery
Congenital abnormality
Environment (temperature, ventilation, sanitation, housing)
Poor nutrition
Infectious disease
Travel and exposure to other animals 
Condition of littermates

Question 18

Mortality and time in labor:

Stage II

Answer 18

Less than 5 hours; 6% mortality
5 to 24 hours: 13.7%
More than 24 hours: >90%

Question 19

Maternal Causes of Neonatal Death

Answer 19

Maternal neglect 
Immaturity/anxiety/cannibalism
Mastitis
Metritis
Sub involution of placental sites

Question 20

Hypothermia

Answer 20

Rewarm over 1-3 hours!

Place in incubator (warmth, oxygen, and humidity control)
Recirculating water heating pads (be careful for thermal burns)

Do NOT use electric eating pads, hot water bottles, or rice bags directly on puppies

Goal: get to 98 but not above

Question 21

Dehydration (hypovolemia)

Physiology

Answer 21

Do NOT give oral fluids if temperature is less than 94; will kill puppy

Gastric and intestinal motility diminished which causes aspiration pneumonia

Question 22

Dehydration (hypovolemia)

Treatment

Answer 22

Administer 1 mL LRS + 2.5 mL 10% dextrose per 30 grams body weight IV or intraosseous (proximal tibia, greater trochanter, proximal humerus)

Repeat once every 15 minutes until rehydrated (urine production)

Question 23

Hypoglycemia

Treatment

Answer 23

Administer 0.25 mL 10% dextrose per 30 grams body weight by stomach tube; body temperature must be above 94

Warmed orphan formula may be administered as supplement (must be warm)

Question 24

Hypoxia

Causes

Answer 24

Sepsis
Pneumonia
Hypothermia

Question 25

Hypoxia

Treatment

Answer 25

Flow-by 30-40%

Do not give for too long or can cause vitreous fibroplasia

Question 26

Drug Therapy

Anemia

Answer 26

Blood transfusion

Question 27

Drug Therapy

FPT

Answer 27

Serum

Question 28

Drug Therapy

Antibiotics

Answer 28

Ampicillin-clavulanate
Cephalosporins
Amikacin (watch hydration status; renal caution)

Question 29

Drug Therapy

Fading Neonate

Answer 29

L-thyroxine if no apparent underlying cause

Question 30

Three main components of milk

Answer 30

Protein
Fat
Lactose

Question 31

Hand Raising Puppies
How much
How often

Answer 31

105-120 kcal/pound body weight daily

Feed every 2-4 hours for the first 3 days then every 4-6 hours

Do NOT wake neonates if they appear full

Question 32

Hand Raising Kittens
How much
How often

Answer 32

100-175 kcal/pound body weight daily

Feed every 2-4 hours for the first 3 days then every 4-6 hours

Do NOT wake neonates if they appear full

Question 33

What laboratory value is always increased in neonates? Why?

Answer 33

GGT

Colostrum