Neonatal Care Flashcards
What are the 4 main physiologic reasons for neonatal death?
Hypothermia
Hypoxia
Hypoglycemia
Hypovolemia
10 to 20% of deaths occur in first week of life
What is considered neonate?
Birth to 2 weeks
What is considered pediatric/infant?
2 weeks to 8 weeks
At birth puppies and kittens are:
Blind
Poikilothermic
Have limited mobility
Entirely dependent on mother for survival
Cardiovascular
Physiology and Anatomy
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
Week 1 vs Week 4: Heart Rate and Blood Pressure
Week 1: High HR (200+) low BP (50)
Week 4: Normalize HR (110) and BP (140)
Cardiovascular System
Anoxia
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
First Breaths
Stimulation
Importance
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
First Breaths
Physiology
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
First Breaths
Innervention
Can clear airways with suction
Could intubate and give a tiny puff of air; do not over inflate lungs, very fragile
Puppies and Fluid Composition
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
Renal Development
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
Gastrointestinal Development
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)
Neonatal TPR
T: 97
HR: 200 bpm
R: 15 to 35 bpm
What can cause bradycardia in a neonate?
Hypothermia
Hypoxia
Body Weight
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
Factors Affecting Neonatal Survival
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
Mortality and time in labor:
Stage II
Less than 5 hours; 6% mortality
5 to 24 hours: 13.7%
More than 24 hours: >90%
Maternal Causes of Neonatal Death
Maternal neglect Immaturity/anxiety/cannibalism Mastitis Metritis Sub involution of placental sites
Hypothermia
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
Dehydration (hypovolemia)
Physiology
Do NOT give oral fluids if temperature is less than 94; will kill puppy
Gastric and intestinal motility diminished which causes aspiration pneumonia
Dehydration (hypovolemia)
Treatment
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)
Hypoglycemia
Treatment
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)
Hypoxia
Causes
Sepsis
Pneumonia
Hypothermia
Hypoxia
Treatment
Flow-by 30-40%
Do not give for too long or can cause vitreous fibroplasia
Drug Therapy
Anemia
Blood transfusion
Drug Therapy
FPT
Serum
Drug Therapy
Antibiotics
Ampicillin-clavulanate
Cephalosporins
Amikacin (watch hydration status; renal caution)
Drug Therapy
Fading Neonate
L-thyroxine if no apparent underlying cause
Three main components of milk
Protein
Fat
Lactose
Hand Raising Puppies
How much
How often
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
Hand Raising Kittens
How much
How often
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
What laboratory value is always increased in neonates? Why?
GGT
Colostrum
