Neonatology Flashcards
describe indications for rescusitation
puppies should spontaneously breathe within 1 minute of birth
resuscitate if:
-not breathing within 1 min
-C-section
-dystocia
describe the ABCs of resuscitation
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
describe what to do if basic breathing resuscitation is ineffective
- positive pressure with a mask
- piglet resuscitator
- ET intubation and rebreathing bag
-2mm ET tube or 12-16G catheter
-challenging but doable, likely traumatize airway - dopram (doxapram) BAD
-resp stimulant unlikely to improve hypoxemia due to hypoventilation
-no longer rec in human med (Ellerbrock no use either) - naloxone 0.1 mg/kg IF dam was given an opioid premed
- 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
what structures run through the umbilicus?
- urachus: from bladder to umbilicus, hard to find (hard to accidentally inject)
- umbilical arteries: draining blood from fetus back through umbilical cord
-become round ligaments of bladder - 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
when do you give up with puppy resuscitation?
- no change in 20 minutes and puppy is warm! or if see:
-agonal respiration
-bradycardia that is not improving - serious congenital defects:
-loud murmurs
-hydrocephalus, anasarca
-gastrotroschisis, large omphalocele, large fontanel
after the ABCs, what do you do for neonates?
- thermal support:
-heat lamps, hot fluid bags, water blankets - bedding
- dextrose!
-neonates have no glucose reserve, limited gluconeogenesis
describe neonatal development
- neurologic maturation: 21d
- eyes open: 9-16d
- ear canals open: 10-14d
- adult parameters: not until 5-10 weeks of life
- thermoregulation: poor until 28d
- solid food: within 28d
- postural control: 3-5 weeks
describe puppy apgar score
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
after resuscitation, what do for puppies?
- brief PE:
-MM, suckle reflex, movement
-oral cavity, hair coat, limbs, umbilicus
-urogenital structures: when stimulate should urinate
-auscultation heart and lungs - screen for birth defects: atresia ani, cleft palate, hare lip, etc.
- TPR:
-T: 96-97 (30 min post birth, warm up from there, only check if worried)
-P: >200bpm
R: 15-30bpm
describe umbilical care
- after puppy warm, pink, moving
- 2% iodine dip to prevent ascending infections
- leave 0.5-1.0cm if cutting cord, then ligate with suture
describe evaluating the neonate neurologically
- neonatal neurologic exam:
-suckling
-righting
-rooting
-need neurologic maturation before can do normal neuro exam! - panniculus/cutaneous trunci reflex present at birth
- flexor (pain/withdrawal) reflex present shortly after birth
- crossed extension reflex:
-pinch on foot, opposite limb extends
-present up to 3 weeks of age (disappear after that) - anogenital reflex:
-dam stimulates anus/urethral opening, results in urination and defecation - rooting and suckling reflexes disappear by 4 weeks in normal pups
- cranial nerve exam after 3 weeks of age
describe assessment of birth weight
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
describe normal weight gain
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
why would a puppy not be gaining weight? describe interventions for each
- inadequate lactation:
-give domperidone, oxytocin, and treat maternal health - dam rejection:
-give acepromazine, placenta, oxytocin - illness:
-antibiotics or antiparasitics - large litter:
-supplement with milk replacer!
-230-260kcal/kg
-6-8 feedings
-bottle, tube, or sponge
describe bottle feeding of a 200g puppy
- goal is 250 kcal/kg
- puppy stomach capacity is 40ml/kg (very small!)
- 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)
describe trouble shooting milk replacers
- if see osmotic diarrhea:
-dilute 25-50% with water or LRS - proper feeding technique:
-limit regurg and prevent aspiration pneumonia - bloating:
-start with 50% recommended volume per feeding and gradually increase
-give less volume more frequently
describe warning signals of puppies
- vocalization:
<20 min at a time: normal
>20 min at a time: pain, illness (CHV-1), hunger, cold - tachypnea, hypoventilation, or irregular breathing
-normally 25-35 breaths per min in 1st couple weeks
what are 3 big puppy threats that go hand in hand?
- hypoglycemia
- hypothermia: if cold, no nurse and GI no work and develop ileus, become bradycardic and hypoglycemia
- dehydration
how warm should puppies be?
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!
describe dehydration in puppies
- when USG >1.017
- supplement using balanced crystalloids
-bolus 30ml/kg
-maintenance: 3-6ml/kg/hr
-SQ!! or PO, IV, IO, IP - keep puppy and fluids warm!
describe hypoglycemia in puppies
- 0.5-1g/kg dextrose
- 2ml/kg IV 10%
- drop on gums 50% dextrose
- usually as single dose, multi doses can lead to hyperglycemia
describe neonatal septicemia
- 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 - results in hypoxia induced bacterial translocation, aspiration pneumonia, umbilical infections
- treatment of septicemia
-most common bacteria are E. coli, streptococci, staph, or klebsiella - treat with ceftiofur, amoxi/clav, TMS, cephalexin, penicillin, macrolides, amikacin
-do not give enrofloxacin or ciprofloxacin!!
describe treatment of the ill puppy
- external warmth, oxygen supplementation, turn to side if can’t right self
- electrolyte fluids, dextrose 5%, empirical antibiotics
- oral feeding if suckle reflex, tube feeding if no suckle/swallow reflex
describe maternal colostrum
- optimal absorotpion before 8 hours old
- no oral absorption after 24-48 hr
- how to optimize:
-adequate C section timing
-adequate nutrition
-proper vaccination - 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
describe domperidone
- D2 dopamine antagonists
- increase prolactin (increase milk letdown, not change milk production)
describe puppy rejection
- when see it:
-retain placentas to rub on puppies after C sections
-oxytocin
-DAP collar, diffuser
-azepromazine - make sure dam illness not reason
-mastitis
-hypocalcemia
-metritis
-pain from sx - quiet environment and whelping box
- puppies should never be left alone with dam 1st 2 weeks
describe puppy vaccinations
- maternal antibodies decline between 6-16 weeks
- maternal Abs interfere with vaccine antigen
- multiple sequential vaccines recommended
- for distemper, adenovirus, and parvo:
1st vx: 6-9 wks, then q3 weeks until 16 weeks then yearly - for rabies: 1st vx: 12 or 16 weeks, then boost yearly
- non core given based on individual risk assessment
describe puppy worming protocols
- worm puppies every 2 weeks until 12 weeks old, then monthly to 6 months
-or until on monthly preventative - worm bitch prior to breed, 10 days before whelp, then every 3 weeks until weaning
-goal: prevent transmammary hookworm and roundworm
