Neonatal/Pediatric ER (Allen) Flashcards
Neonate
- Birth through 2-3 weeks
- Able to walk
- Capable of spontaneous urination and defecation
Pediatric
- 2-3 weeks of age until 4-6 months of age
Comprehensive neonate history
- Duration of illness
- CS noted by owner
- Number affected in litter
- Treatments provided
- Dam history
- Colostrum ingestion
- Birth weight
Colostrum
- Endotheliochorial placenta
- limits offspring antibodies
- up to 25% kittens
- maybe 5-10% dogs
- limits offspring antibodies
- Max absorption at 8 hours
- Measuring
- compare ALP and GGT
- measure IgG
- Can supplement
- PO
- SC
Birth Weights
- Kittens
- average 100g
- 1 lb/month
- Puppies
- toy breeds
- 120 g
- medium breeds
- 250 g
- Large breed
- 490 g
- Giant breed
- 625 g
- toy breeds
Expected weight gain
- Kittens
- 7-10 grams/day
- may lose some weight in first 24 hrs
- should double by 7-10 d
- Puppies
- 1 g/lb of expected adult weight
- may lose some weight in first 24 hrs
- should double by 7-10 days
Records
- Identify females/males
- Attach paper collars with neonate number
- Have individual records on each patient
- Gram scale to monitor daily weight/trends
Normal puppy vitals
1 week old
- T: 99.5
- P: 180-220 beats/min
- RR: 32 breaths/min
- mm: hyperemic
Thermoregulation
- Poor
- limited ability to shiver
- limited ability to vasoconstrict
- larger surface area to body mass
- little body fat
- poor blood flow to extremities
- high water compensation
- unable to pant
Normal neonate temp
- week 1
- rectal temp: 96-97
- environmental temp: 86-90
- week 2-3
- 97-100
- environmental temp: 80-85
- week 4
- rectal temp: 99-101
- environmental temp: 70-75
Complications of hypothermia
- Depressed respirations
- bradycardia
- ileus
- don’t feed until normothermic
- coma
Cardiovascular system
Neonate vs adult
- Lower than adult
- blood pressure
- stroke volume
- peripheral vascular resistance
- Higher than adult
- heart rate
- cardiac output
- plasma volume
- central venous pressure
Cardiovascular system
neonate
- Immature autonomic nervous system
- lack of baroreceptor control
- Under-developed control on myocardial contractility
- No sinus arrhythmia
- Heart rate
- week 1: 200-220 bpm
- Bradycardia and hypotension
- often due to hypoxemia
- Murmurs common during first week
- closure DA
- if persistent - investigate
Respiratory system
- Fetus: blood-gas exchange across placenta
- Fetal cortisol => surfactant
- Umbilical cord separation
- hypoxia
- inc vascular resistance
- Dyspnea
- reflex contraction of thoracic muscles
- negative airway pressure
- breathe
Resp system normals
- 15-20 breaths/min in newborns
- 20-30 breaths/min
- inc resp rate in neonates
- normalizes in pediatric period
- be mindful of resp dep drugs
Gi system
- Oral cavity
- cleft palate
- cleft lip
- teeth
- abdoment soft and compliant
Urogenital
- urogenital openings
- atresia ani
- check for patency of urinary system
- stimulation
- nephrogenesis first 2 weeks
- GFR: adult level at 8 weeks
Umbilical cord
- Clean and dry
- no redness, swelling, d/c
- falls off in 2-3 days
- Omphalitis
- infection of umbilical cord
Sensory organs
NOT TEST QUESTION
- Eyelids separate 5-14 days
- corneal edema for 2-3 weeks
- menace and PLRs 10-21 days
- Fundic exam unreliable during neonate period
- ear canals open 6-14 days
Neuro system
- Skull palpation
- assess for closure of bregmatic fontanelle
- Righting reflex
- Rooting reflex
- Suckle reflex
- Flexor dominance 0-4 days
- Extensor dominance 5-21 days
Normal neonate
- Strong suckle
- Cry in response to
- pain
- hunger
- cold
- loss of maternal contact
- Sleep after nursing
- Hyperemeic mucus membranes
Fluid requirements
- Higher in neonates
- 80-100 ml/kg/day
- reasons
- higher % total body water
- greater surface area to body weight ratio
- higher metabolic rate
- decreased renal concentrating ability
- decreased body fat
Assessing hydration status
- Weight
- Urine color
- should look like water
- Mucus membranes
- Severe dehydration (10-15%)
- pale mm
- slow CRT in absence of anemia
- Severe dehydration (10-15%)
- Thoracic rads
- Hct, total solids
- 30 normal, I think
Routes of fluid admin
- PO
- IV
- 20-40 ml/kg shock volume
- LRS
- IO: intraosseous
- SC: subcutaneous
Intraosseous catheter
locations
- Intertrochanteric fossa
- Tibial crest
- Proximal humerus
Cysto
is possible in neonates
Hematopoietic system

Urinary system differences
- Over first month
- GFR inc 7x
- RBF inc 4x
- BUN higher at birth
- decreases between 2wks-3 months
- USG: 1.006-1.017
- 50% neonates have glucosuria
Biochemical differences
- Sodium and Chloride slightly lower
- Potassium
- low at 2-4 weeks
- peaks 6-8 weeks
- Bilirubin slightly higher
- ALP and GGT up to 20 x higher
- Phosphorus higher
Coagluations system
- Lower concentration clotting factors and antithrombin
- Prothrombin time (PT) about 1.3x adult
- Partial thromboplastin time (aPTT) about 1.8x adult
- Platelets similar to adult
Imaging rads
- Thorax
- thymus on left
- heart bigger
- interstitial lung pattern
- Abdomen
- liver appears larger
- loss of detail
*normally useless in babies
PRRA can cause
megaesophagus (I think)
Pharmacological considerations
- lower
- body fat
- total protein
- Immature kidneys and liver
- Liver complicated as neonates
- if need activation, expect less circulating drug conc
- if need activations for excretion, expect higher circulating concentrations
- Permeable GI tract first 72 hours
Pharmacological considerations
antibiotics
- BBB not fully developed
- Antibiotics
- avoid aminoglycocides
- unable to monitor
- no chloramphenical
- BM suppression
- no sulfonamides
- BM suppression
- no tetracyclines
- skeletal/dentition abnormalities
- avoid fluoroquinolones
- cartilage damange
- avoid aminoglycocides
ok antibiotics for neonates
- b-lactams
- metronidazole
Analgesics and anesthetics
- Opioids
- lower doses in younger patients
- fentanyl ideal - Naloxone
- lower doses in younger patients
- Local anesthetics
- lidocaine
- max dose neonatal kittens: 3 mg/kg
- max dose puppies: 6mg/kg
- EMLA cream
- lidocaine
- no NSAIDS
Common emergencies
- Hypothermia
- Hypovolemia and dehydration
- Hypoglycemia
- Hypoxemia
- Sepsis
- Trauma
- ESP TBI
Hypovolemia and dehydration
- Poor perfusion and decreased oxygen delivery to tissues
- more susceptible to volume loss
- poor compensatory mechanisms
- ANS not mature until 8 weeks
- Causes
- diarrhea
- vomiting
- decrearsed intake
Hypobolemia and dehydration
Treatment
- If hypovolemic IV or IO access
- 20-40 ml/kg warm IV fluid bolus
- re-exam patient
- If dehydrated, IV, IO, PO
- depends on circumstances
- Daily fluid requirement
- 80-100 ml/kg/day
- Weigh q6-12h
Hypoglycemia
- Neonates more susceptible
- inefficient hepatic gluconeogenesis
- decreased hepatic glycogen stores
- glucosuria (50%
- inefficient counter regulatory hormones
- epi
- growth hormone
- cortisol
- glucagon
- CNS energy substrate
- Neonatal myocardium reliant
*Dextrose: 1 ml/kg 50% (dilued 1:3) IV then CRI 2.5-5%
Hypoxemia
Ddx
- At birth
- pulmonary hypertension
- decrearsed surfactant
- aspiration of meconium or periparturient fluid
- congenital defect
- Days to weeks
- aspiration
- infection
- congenital defects
Hypoxemia TX
- Oxygen
- IV antibiotics if pneumonia
- potentiated beta-lactams
- Nutritional support
- Heat support
Sepsis
- Sources of infection
- Oomphalitis
- Tail docking
- Pneumonia
- GI infections
- Etiologic agents
- Staphylococcus
- Streptococcus
- E. Coli
- Pseudomonas
*lack of colostrum increases risk
Sepsis
Treatment
- Source of control
- IV fluids
- Dextrose
- Antibiotics IV
- Nutritional support
- Heat support
- +/- inotropes
Traumatic brain injury
- NO swinging during resuscitation
- subdural hematoma
- Trauma
- Treatment goals
- improve oxygen delivery
- decrease ICP
- maximize CPP
Parasitemia
- 2-4 weeks of age
- Type
- roundworms
- hookworms
- coccidia
- giardia
- fleas
- ticks
- mycoplasma (cats)
Parasitemia
Signs
Diagnostics
TX
- Signs
- pale mm
- tachycardia
- lethargy
- hypothermia
- visual infestation
- DX
- PCV/TX
- NOVA
- blood smear
- Treatment
- Blood transfusions (if severe)
- Deworm
- Re-hydrate
- No ‘safe’ flea treatment
BOARD QUESTION

mycoplasma haemophilus
- common in kittens
- epicellular
- fresh blood smear
Neonatal resuscitation station
- Trained staff
- Sterile drapes
- Bulb or tube suction
- Small face masks
- Small ET tubes
- Reversal agents
- Hemostats
- Suture and dilute betadine
- Warm area for recovery
Neonatal resuscitation
- flow-by oxygen
- DV position
- extended head
- stim of respiration
- GV26
- doxopram: 1 drop sublingual
Neonatal Isoerythrolysis (NI)
- Immune mediated destruction of kitten’s erythrocytes by queen’s antibodies
- Kittens with type A or AB blood nurse from t ype B queen
- Queen passes anti-A IgG antibodies in colostrum
NI CS
- Dead
- stop nursing
- weak
- hemoglobinuria
- jaundice
- anemia
- tachycardia
- tachypnea
- tail necrosis
NI TX
- Transfusion
- give mom’s blood first 3 days
- must wash the red cells
- after 3 days give type A blood
- give mom’s blood first 3 days
Wrap up
Know these
- Normal physical examination findings
- Importance of colostrum
- Physiological differences
- Packed cell volume difference
- Fluid requirements
- Common ER