Neonatology

Question 1

describe indications for rescusitation

Answer 1

puppies should spontaneously breathe within 1 minute of birth

resuscitate if:
-not breathing within 1 min
-C-section
-dystocia

Question 2

describe the ABCs of resuscitation

Answer 2

Airway:
-remove fetal membranes
-gentle suction (bulb syringe or aspirator)
-keep head below thorax for fluid drainage
-DO NOT SWING

Breathing:
-promote breathing via brisk rubbing with a towel! (like mom)
-keep warm!!
-ventilatory support: flow by oxygen by face mask
-GV 26 acupuncture point: needle in nasal philtrum at base of nares

Circulation:
-bradycardia usually due to hypoxia, cardiac massage/CPR 1-2 beats per sec
-persistent bradycardia:
–epinephrine 10-200 ug/kg IV (umbilical, cephalic, jugular) or IO (proximal femur, humerus)
–MUST continue cardiac massage or drug won’t circulate!!
–atropine is NOT advised: bradycardia is hypoxemia-induced myocardia depression, not vagal mediated, so anticholinergic tachycardia worsens oxygen deficits

Question 3

describe what to do if basic breathing resuscitation is ineffective

Answer 3

1. positive pressure with a mask
2. piglet resuscitator
3. ET intubation and rebreathing bag
   -2mm ET tube or 12-16G catheter
   -challenging but doable, likely traumatize airway
4. dopram (doxapram) BAD
   -resp stimulant unlikely to improve hypoxemia due to hypoventilation
   -no longer rec in human med (Ellerbrock no use either)
5. naloxone 0.1 mg/kg IF dam was given an opioid premed
6. tight fitting mask and head extended to limit air forced into stomach
   -20cm water pressure for 3 sec to expand lungs
   -then 30 breaths/min (1 second per breath) until neonate breathing spontaneously

Question 4

what structures run through the umbilicus?

Answer 4

1. urachus: from bladder to umbilicus, hard to find (hard to accidentally inject)
2. umbilical arteries: draining blood from fetus back through umbilical cord
   -become round ligaments of bladder
3. umbilical veins: going cranially toward liver
   -become falciform ligament
   -aim for the veins when injecting epi ideally! (towards liver and then towards heart)

look for vein or artery on ultrasound and how far infection extends when have umbilical infection as well

Question 5

when do you give up with puppy resuscitation?

Answer 5

1. no change in 20 minutes and puppy is warm! or if see:
   -agonal respiration
   -bradycardia that is not improving
2. serious congenital defects:
   -loud murmurs
   -hydrocephalus, anasarca
   -gastrotroschisis, large omphalocele, large fontanel

Question 6

after the ABCs, what do you do for neonates?

Answer 6

1. thermal support:
   -heat lamps, hot fluid bags, water blankets
2. bedding
3. dextrose!
   -neonates have no glucose reserve, limited gluconeogenesis

Question 7

describe neonatal development

Answer 7

1. neurologic maturation: 21d
2. eyes open: 9-16d
3. ear canals open: 10-14d
4. adult parameters: not until 5-10 weeks of life
5. thermoregulation: poor until 28d
6. solid food: within 28d
7. postural control: 3-5 weeks

Question 8

describe puppy apgar score

Answer 8

at birth, post resuscitation to ID those still at risk of developing issues

parameters:
-HR: want >220
-vocalization/resp rate: want crying, >15
-reflex irritability: vigorous want
-motility: want active
-mucous membranes: want pink

0-3: severe distress
4-6: mod distress, watch and close care
7-10: no distress

Question 9

after resuscitation, what do for puppies?

Answer 9

1. brief PE:
   -MM, suckle reflex, movement
   -oral cavity, hair coat, limbs, umbilicus
   -urogenital structures: when stimulate should urinate
   -auscultation heart and lungs
2. screen for birth defects: atresia ani, cleft palate, hare lip, etc.
3. TPR:
   -T: 96-97 (30 min post birth, warm up from there, only check if worried)
   -P: >200bpm
   R: 15-30bpm

Question 10

describe umbilical care

Answer 10

1. after puppy warm, pink, moving
2. 2% iodine dip to prevent ascending infections
3. leave 0.5-1.0cm if cutting cord, then ligate with suture

Question 11

describe evaluating the neonate neurologically

Answer 11

1. neonatal neurologic exam:
   -suckling
   -righting
   -rooting
   -need neurologic maturation before can do normal neuro exam!
2. panniculus/cutaneous trunci reflex present at birth
3. flexor (pain/withdrawal) reflex present shortly after birth
4. crossed extension reflex:
   -pinch on foot, opposite limb extends
   -present up to 3 weeks of age (disappear after that)
5. anogenital reflex:
   -dam stimulates anus/urethral opening, results in urination and defecation
6. rooting and suckling reflexes disappear by 4 weeks in normal pups
7. cranial nerve exam after 3 weeks of age

Question 12

describe assessment of birth weight

Answer 12

ID and weigh puppies
-if less than 25% of mean birth weight normally don’t survive

-low birthweight can be due to placental health/insufficiency, maternal age/health/environment/nutrition, litter size, or congenital abnormalities

Question 13

describe normal weight gain

Answer 13

should gain around 10%/day or
1-3g/pound of anticipated adult weight weekly

not abnormal to lose weight in 1st 24 hours as figuring out life

Question 14

why would a puppy not be gaining weight? describe interventions for each

Answer 14

1. inadequate lactation:
   -give domperidone, oxytocin, and treat maternal health
2. dam rejection:
   -give acepromazine, placenta, oxytocin
3. illness:
   -antibiotics or antiparasitics
4. large litter:
   -supplement with milk replacer!
   -230-260kcal/kg
   -6-8 feedings
   -bottle, tube, or sponge

Question 15

describe bottle feeding of a 200g puppy

Answer 15

1. goal is 250 kcal/kg
2. puppy stomach capacity is 40ml/kg (very small!)
3. better to underfeed than bloat the puppy; so use multiple feedings to break up (no more than 8 ml at a time)
   -ideally start with 12 feedings/day (every 2 hours)

Question 16

describe trouble shooting milk replacers

Answer 16

1. if see osmotic diarrhea:
   -dilute 25-50% with water or LRS
2. proper feeding technique:
   -limit regurg and prevent aspiration pneumonia
3. bloating:
   -start with 50% recommended volume per feeding and gradually increase
   -give less volume more frequently

Question 17

describe warning signals of puppies

Answer 17

1. vocalization:
   <20 min at a time: normal
   >20 min at a time: pain, illness (CHV-1), hunger, cold
2. tachypnea, hypoventilation, or irregular breathing
   -normally 25-35 breaths per min in 1st couple weeks

Question 18

what are 3 big puppy threats that go hand in hand?

Answer 18

1. hypoglycemia
2. hypothermia: if cold, no nurse and GI no work and develop ileus, become bradycardic and hypoglycemia
3. dehydration

Question 19

how warm should puppies be?

Answer 19

week 1:
-external: 85-90
-puppy: 95-99

week 2:
-external: 80
pup: 97-100

week 3:
-external: 70-75
-pup: 99-101

give dam a way to get cool!

Question 20

describe dehydration in puppies

Answer 20

1. when USG >1.017
2. supplement using balanced crystalloids
   -bolus 30ml/kg
   -maintenance: 3-6ml/kg/hr
   -SQ!! or PO, IV, IO, IP
3. keep puppy and fluids warm!

Question 21

describe hypoglycemia in puppies

Answer 21

1. 0.5-1g/kg dextrose
2. 2ml/kg IV 10%
3. drop on gums 50% dextrose
4. usually as single dose, multi doses can lead to hyperglycemia

Question 22

describe neonatal septicemia

Answer 22

1. stress, low birth weight, hypothermia result in failure of passive transfer of IgG +/- exposure to pathogens
   -risk factors: dam endometritis, dam agalactia, dystocia, milk replacers
2. results in hypoxia induced bacterial translocation, aspiration pneumonia, umbilical infections
3. treatment of septicemia
   -most common bacteria are E. coli, streptococci, staph, or klebsiella
4. treat with ceftiofur, amoxi/clav, TMS, cephalexin, penicillin, macrolides, amikacin
   -do not give enrofloxacin or ciprofloxacin!!

Question 23

describe treatment of the ill puppy

Answer 23

1. external warmth, oxygen supplementation, turn to side if can’t right self
2. electrolyte fluids, dextrose 5%, empirical antibiotics
3. oral feeding if suckle reflex, tube feeding if no suckle/swallow reflex

Question 24

describe maternal colostrum

Answer 24

1. optimal absorotpion before 8 hours old
2. no oral absorption after 24-48 hr
3. how to optimize:
   -adequate C section timing
   -adequate nutrition
   -proper vaccination
4. if inadequate
   -domperidone
   -maternal serume or hyperimmune plasma
   <24 hrs post birth give 20-30ml/kg PO
   >24 hr old give 20-30 ml/kg SQ q 6 hr fo 3 doses

Question 25

describe domperidone

Answer 25

1. D2 dopamine antagonists
2. increase prolactin (increase milk letdown, not change milk production)

Question 26

describe puppy rejection

Answer 26

1. when see it:
   -retain placentas to rub on puppies after C sections
   -oxytocin
   -DAP collar, diffuser
   -azepromazine
2. make sure dam illness not reason
   -mastitis
   -hypocalcemia
   -metritis
   -pain from sx
3. quiet environment and whelping box
4. puppies should never be left alone with dam 1st 2 weeks

Question 27

describe puppy vaccinations

Answer 27

1. maternal antibodies decline between 6-16 weeks
2. maternal Abs interfere with vaccine antigen
3. multiple sequential vaccines recommended
4. for distemper, adenovirus, and parvo:
   1st vx: 6-9 wks, then q3 weeks until 16 weeks then yearly
5. for rabies: 1st vx: 12 or 16 weeks, then boost yearly
6. non core given based on individual risk assessment

Question 28

describe puppy worming protocols

Answer 28

1. worm puppies every 2 weeks until 12 weeks old, then monthly to 6 months
   -or until on monthly preventative
2. worm bitch prior to breed, 10 days before whelp, then every 3 weeks until weaning
   -goal: prevent transmammary hookworm and roundworm