Neonatology Flashcards
when do most neonatal deaths occur
in the first week of life
what are most neonatal deaths caused by
◦ Poor husbandry practices
◦ Suboptimal management
◦ Poor mothering
are most neonatal deaths preventable
YES
pups lungs in utero vs at birth
in utero = fluid filled
at birth = inflate with air
pups hearts in utero vs at birth
in utero = Right side of the heart (to the lungs) = essentially high pressure system. Causes blood to shunt from R side of the heart to the L
at birth = Right side of the heart = low pressure system. No longer any shunting from R to L = pressure on L side is actually greater than the R side
(Ductus arteriosus and Foramen ovale closes)
function of ductus arteriosis and foramen ovale
◦ Ductus arteriosus = blood goes from pulmonary artery to aorta
◦ Foramen ovale = blood goes from right atrium to left atrium
what is the most common prenatal condition
◦ Most common prenatal condition = fetal hypoxia (maternal stress, compromise,
dystocia, etc.)
where do neonates get oxygen from in utero
placenta
what happens just before birth with the adrenal glands
◦ Just before birth: adrenal glands = cortisol = stimulates production of surfactant
what happens when the umbilical cord is cut
◦ When umbilical cord blood supply is cut = hypoxia + inc in vascular resistance = dyspnea = reflex contraction of the chest
what happens in newborns related to the respiratory system
◦ In newborns = inability to inflate lungs = hypoxia
what cant neonates compensate well for and why
Neonates cannot compensate well for:
◦ Hemorrhage
◦ Hyperthermia
◦ Acid/base imbalances
This is due to poor myocardial contractility
why do neonates not have good BP control
Have incomplete autonomic innervation of heart and vasculature = not good blood pressure control
what happens at birth related to CV system
◦ inc oxygen tension = ductus arteriosus narrows & pulmonary vessels dilate
◦ inc left-sided pressure = closure of foramen ovale
why are neonates more sensitive to temperture fluctuations (7)
◦ They cannot shiver
◦ They cannot vasoconstrict
◦ They have inc surface area:body mass ratio
◦ Have little body fat
◦ Have poor blood flow to extremities
◦ Have high water composition
◦ Are unable to pant
what is the result of the high stomach pH in neonates
more susceptible to bacterial infections
when does gut permeability start to decrease
Gut permeability starts to dec 8hrs after birth; virtually none by 24hrs
colostrum vs transition milk timepoints
Is the 1st mammary secretion produced after delivery = transition to milk at day 2-3 post partum
what % of Abs are passed through placenta in dogs and cats
<5% of antibodies are passed through placenta in dogs; 25% in kittens
-> Almost have no immunoglobulins @ birth
what is the highest % of Ig in colostrum
60-75% IgG
Risk of neonatal mortality depends on 2 factors:
◦ Quality of the transfer of passive immunity
◦ Growth of the puppy between birth & 2 days of age
rules for colostrum replacement
Administer plasma or serum from vaccinated adult
◦ Oral if <12hrs old
◦ Subcutaneously if >12hrs old – achieve higher levels when given SQ
If you can, its good to get pooled serum from multiple vaccinated adults of same household
◦ Not ideal to use the dam
Can give as 3 boluses (birth, 12 & 24hrs) or all at once
when to use colostrum replacement
in cases of failure of passive transfer
what does weight loss after first 24hr of life indicate
indication that something might be wrong; can precede clinical signs by 16hrs
how often should pups be weighed
◦ Should weigh pups at least 1x/day à ideally 2x/day – encourage owners to make a chart/graph
normal weight gain in puppies
◦ Normal for weight to decrease in 1st 24hrs (if c- section, less so if natural whelping)
◦ Should then gain 5-10% of their body weight daily
◦ Should double their weight within 7-10 days of age
what aspects of normal neonatal physiology predispose them to hypoglycemia
◦ Are born with limited glycogen stores
◦ Have poor gluconeogenesis capability
◦ Glucose – neonates have an: (Increased demand for it, Increased loss of it, And a decreased ability to synthesize it)
what aspects of neonatal physiology are important when it comes to drug selection
-Decreased renal clearance; Do not have normal glomerular filtration rate until 6 weeks of age
-Decreased hepatic metabolism
aspects of PE (12)
◦ APGAR scoring
◦ Body temperature
◦ Hydration status
◦ Behavior/mentation
◦ Sensory Organs
◦ Neurologic System
◦ Respiratory System
◦ Cardiovascular System
◦ GI/Abdomen
◦ Dermatology
◦ Musculoskeletal System
◦ Reproductive Tract
what does APGAR scoring consist of?
what does a score close to 10 vs under 6 tell us
-Consists of assigning a score (0-2) in each category:
◦ Heart Rate
◦ Spontaneous breathing
◦ Response to an irritating stimulus
◦ Muscle tone
◦ Color of mucous membranes
-Scores close to 10 = associated with neonatal viability
-Scores 6 or lower = associated with neonatal mortality & should receive supportive care
what three extra parameters can be added to APGAR scoring to assess fetal viability
◦ Rooting behavior
◦ Righting reflex
◦ Suckle reflex
common causes of dehydration (2)
◦ Inadequate feeding
◦ GI disturbances (diarrhea, vomiting, anorexia)
what can dehydration lead to
Can lead to hypovolemia quickly = lack of compensatory mechanisms
how to assess dehydration in neonates
◦ Skin tent is not reliable
◦ Mucous membranes – should be deep pink, can be misleading if just nursed
◦ Urine color = should be dilute yellow if well hydrated
how can you do fluid administration in neonates
◦ Oral (if GI is working) ok
◦ Subcutaneous
◦ IV or IO (intraosseous)
causes of hypoglycemia
◦ Diarrhea
◦ Vomiting
◦ Infection
◦ Decreased intake
clinical signs of hypoglycemia
◦ Weakness, anorexia, tremors, crying, coma, seizures
what cant puppies do related to temperature
Puppies cannot shiver or generate heat by moving
how to avoid hypothermia in puppies (4)
-Should not be less than 35C = should not be warmed up more than 1C/hr
-Should be kept warm in environment (heat lamps, warm towels)
-Temperature should be taken regularly
-Can give warm fluids as tx
should you feed a cold puppy, why or why not
NEVER!
bc hypothermia slows gut down = ileus = previously ingested food ferments = gas = bloat
when can sepsis occur
◦ 2nd to wounds (tail docking, ear crops, umbilicus)
◦ Respiratory or GI infections
◦ In utero acquired infection (less common
clinical signs of sepsis
◦ Can be subtle
◦ Hypovolemia
◦ Vocalizing
◦ Reluctance to nurse
◦ Decreased urine output
◦ Increased lactate
◦ Cold extremities
◦ Loss of hair or sloughing of extremities (tail tip, ear tips)
diagnosis of sepsis
◦ Culture of organisms from blood or affected tissues
treatment of sepsis
◦ Warm fluids
◦ Fresh or fresh frozen plasma from well vaccinated adult
◦ Broad spectrum antibiotics
signs of response to therapy in sepsis cases
◦ Less pale MM
◦ Stronger pulse
◦ Warmer extremities
◦ Lower lactate levels
3 potential causes of fading puppy syndrome
◦ Infectious agents = sepsis = most common
◦ Environment
◦ Genetics
2 manifestations of fading puppy syndrome
◦ Sick at birth, born weak & small or with birth defects = unable to nurse = dehydration, hypothermia, hypoglycemia = death within 1st few days of life (Caused by perinatal bacterial infections & respiratory distress_
◦ Neonates initially appear healthy but become weak in 1st few weeks of life = become depressed, anorexic = enter fatal cycle of dehydration & hypothermia
diagnosis of fading puppy syndrome
◦ Can be difficult
◦ Based on history & physical exam findings
◦ Culture & sensitivity of tissues
◦ If neonate can’t be saved à post mortem exam is recommended
clinical signs of canine herpesvirus
◦ Acute
◦ Stop nursing
◦ Vocalize continuously
◦ Death in 1-3 days
diagnosis and prevention of CHV
Hard to diagnose & treat
Prevention = keep warm neonatal environmen
who is most likely to be affected by CHV
Pups under 3 weeks of age = most likely to be affected (Typical to have the quickest growing pup affected)
what does CHV cause in neonates
Causes necrotizing disease in neonates
type A vs B blood type cats and their antibodies
-Type A cats have weak anti-B antibodies
-Type B cats have strong anti-A antibodies
how does neonatal isoerythrolysis occur
◦ Occurs when kittens with type A blood have a dam who’s type B blood
◦ Queen has strong anti-A antibodies in her colostrum
◦ Kittens ingest these anti-A antibodies
◦ Attacks their own type A blood
clinical signs of neonatal isoerythrolysis
◦ Anemia, icterus
◦ Tail tip necrosis
◦ Weakness
◦ Tachypnea
◦ Tachycardia
◦ Hemoglobinuria
◦ Sudden death
◦ Mortality rate is high even with prompt intervention
prevention of neonatal isoerythrolysis
- Avoid mating type B queens to type A toms
- All breeding cats should be blood typed and bred to their own blood type
- Blood type kitten before allowing it to nurse
what to do after kittens born to mismatched blood type mom
Kitten should be removed from the dam and transfused if necessary
◦ Can use washed type B blood or cross-match blood
congenitive disorders; excess vitamin A
midline defects
congenitive disorders; lack of vitamin D
tooth and bone abnormalities
congenitive disorders; feline parvovirus
cerebellar hyperplasia
congenitive disorders; corticosteroids
cleft palate when given at a certain stage of gestation
what other congenitive disorders to look out for
◦ Hare lip, umbilical hernia, anal atresia, skull disorders (open fontanel)
different nutrition for neonates is important if:
Important if:
◦ There’s a need to supplement (large litter)
◦ Have to wean early (maternal illness)
◦ In orphaned or neonates that needs additional support (runt of the litter, not gaining well)
◦ Can do bottle feeding, sponge feeding or tube feeding
◦ Commercial milk replacer is recommended over home-made
how often should neonates be fed
◦ Newborns need to be fed 6-8x daily (once every 2hrs)
◦ Once they are a couple weeks old = can increase intervals
◦ Food should be warmed to 38.6C
◦ Average stomach capacity = 4tsp per lb
