Neonatology

Question 1

when do most neonatal deaths occur

Answer 1

in the first week of life

Question 2

what are most neonatal deaths caused by

Answer 2

◦ Poor husbandry practices
◦ Suboptimal management
◦ Poor mothering

Question 3

are most neonatal deaths preventable

Answer 3

YES

Question 4

pups lungs in utero vs at birth

Answer 4

in utero = fluid filled
at birth = inflate with air

Question 5

pups hearts in utero vs at birth

Answer 5

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)

Question 6

function of ductus arteriosis and foramen ovale

Answer 6

◦ Ductus arteriosus = blood goes from pulmonary artery to aorta
◦ Foramen ovale = blood goes from right atrium to left atrium

Question 7

what is the most common prenatal condition

Answer 7

◦ Most common prenatal condition = fetal hypoxia (maternal stress, compromise,
dystocia, etc.)

Question 8

where do neonates get oxygen from in utero

Answer 8

placenta

Question 9

what happens just before birth with the adrenal glands

Answer 9

◦ Just before birth: adrenal glands = cortisol = stimulates production of surfactant

Question 10

what happens when the umbilical cord is cut

Answer 10

◦ When umbilical cord blood supply is cut = hypoxia + inc in vascular resistance = dyspnea = reflex contraction of the chest

Question 11

what happens in newborns related to the respiratory system

Answer 11

◦ In newborns = inability to inflate lungs = hypoxia

Question 12

what cant neonates compensate well for and why

Answer 12

Neonates cannot compensate well for:
◦ Hemorrhage
◦ Hyperthermia
◦ Acid/base imbalances

This is due to poor myocardial contractility

Question 13

why do neonates not have good BP control

Answer 13

Have incomplete autonomic innervation of heart and vasculature = not good blood pressure control

Question 14

what happens at birth related to CV system

Answer 14

◦ inc oxygen tension = ductus arteriosus narrows & pulmonary vessels dilate
◦ inc left-sided pressure = closure of foramen ovale

Question 15

why are neonates more sensitive to temperture fluctuations (7)

Answer 15

◦ 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

Question 16

what is the result of the high stomach pH in neonates

Answer 16

more susceptible to bacterial infections

Question 17

when does gut permeability start to decrease

Answer 17

Gut permeability starts to dec 8hrs after birth; virtually none by 24hrs

Question 18

colostrum vs transition milk timepoints

Answer 18

Is the 1st mammary secretion produced after delivery = transition to milk at day 2-3 post partum

Question 19

what % of Abs are passed through placenta in dogs and cats

Answer 19

<5% of antibodies are passed through placenta in dogs; 25% in kittens
-> Almost have no immunoglobulins @ birth

Question 20

what is the highest % of Ig in colostrum

Answer 20

60-75% IgG

Question 21

Risk of neonatal mortality depends on 2 factors:

Answer 21

◦ Quality of the transfer of passive immunity
◦ Growth of the puppy between birth & 2 days of age

Question 22

rules for colostrum replacement

Answer 22

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

Question 23

when to use colostrum replacement

Answer 23

in cases of failure of passive transfer

Question 24

what does weight loss after first 24hr of life indicate

Answer 24

indication that something might be wrong; can precede clinical signs by 16hrs

Question 25

how often should pups be weighed

Answer 25

◦ Should weigh pups at least 1x/day à ideally 2x/day – encourage owners to make a chart/graph

Question 26

normal weight gain in puppies

Answer 26

◦ 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

Question 27

what aspects of normal neonatal physiology predispose them to hypoglycemia

Answer 27

◦ 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)

Question 28

what aspects of neonatal physiology are important when it comes to drug selection

Answer 28

-Decreased renal clearance; Do not have normal glomerular filtration rate until 6 weeks of age -Decreased hepatic metabolism

Question 29

aspects of PE (12)

Answer 29

◦ APGAR scoring ◦ Body temperature ◦ Hydration status ◦ Behavior/mentation ◦ Sensory Organs ◦ Neurologic System ◦ Respiratory System ◦ Cardiovascular System ◦ GI/Abdomen ◦ Dermatology ◦ Musculoskeletal System ◦ Reproductive Tract

Question 30

what does APGAR scoring consist of? what does a score close to 10 vs under 6 tell us

Answer 30

-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

Question 31

what three extra parameters can be added to APGAR scoring to assess fetal viability

Answer 31

◦ Rooting behavior ◦ Righting reflex ◦ Suckle reflex

Question 32

common causes of dehydration (2)

Answer 32

◦ Inadequate feeding ◦ GI disturbances (diarrhea, vomiting, anorexia)

Question 33

what can dehydration lead to

Answer 33

Can lead to hypovolemia quickly = lack of compensatory mechanisms

Question 34

how to assess dehydration in neonates

Answer 34

◦ 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

Question 35

how can you do fluid administration in neonates

Answer 35

◦ Oral (if GI is working) ok ◦ Subcutaneous ◦ IV or IO (intraosseous)

Question 36

causes of hypoglycemia

Answer 36

◦ Diarrhea ◦ Vomiting ◦ Infection ◦ Decreased intake

Question 37

clinical signs of hypoglycemia

Answer 37

◦ Weakness, anorexia, tremors, crying, coma, seizures

Question 38

what cant puppies do related to temperature

Answer 38

Puppies cannot shiver or generate heat by moving

Question 39

how to avoid hypothermia in puppies (4)

Answer 39

-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

Question 40

should you feed a cold puppy, why or why not

Answer 40

NEVER! bc hypothermia slows gut down = ileus = previously ingested food ferments = gas = bloat

Question 41

when can sepsis occur

Answer 41

◦ 2nd to wounds (tail docking, ear crops, umbilicus) ◦ Respiratory or GI infections ◦ In utero acquired infection (less common

Question 42

clinical signs of sepsis

Answer 42

◦ 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)

Question 43

diagnosis of sepsis

Answer 43

◦ Culture of organisms from blood or affected tissues

Question 44

treatment of sepsis

Answer 44

◦ Warm fluids ◦ Fresh or fresh frozen plasma from well vaccinated adult ◦ Broad spectrum antibiotics

Question 45

signs of response to therapy in sepsis cases

Answer 45

◦ Less pale MM ◦ Stronger pulse ◦ Warmer extremities ◦ Lower lactate levels

Question 46

3 potential causes of fading puppy syndrome

Answer 46

◦ Infectious agents = sepsis = most common ◦ Environment ◦ Genetics

Question 47

2 manifestations of fading puppy syndrome

Answer 47

◦ 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

Question 48

diagnosis of fading puppy syndrome

Answer 48

◦ 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

Question 49

clinical signs of canine herpesvirus

Answer 49

◦ Acute ◦ Stop nursing ◦ Vocalize continuously ◦ Death in 1-3 days

Question 50

diagnosis and prevention of CHV

Answer 50

Hard to diagnose & treat Prevention = keep warm neonatal environmen

Question 51

who is most likely to be affected by CHV

Answer 51

Pups under 3 weeks of age = most likely to be affected (Typical to have the quickest growing pup affected)

Question 52

what does CHV cause in neonates

Answer 52

Causes necrotizing disease in neonates

Question 53

type A vs B blood type cats and their antibodies

Answer 53

-Type A cats have weak anti-B antibodies -Type B cats have strong anti-A antibodies

Question 54

how does neonatal isoerythrolysis occur

Answer 54

◦ 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

Question 55

clinical signs of neonatal isoerythrolysis

Answer 55

◦ Anemia, icterus ◦ Tail tip necrosis ◦ Weakness ◦ Tachypnea ◦ Tachycardia ◦ Hemoglobinuria ◦ Sudden death ◦ Mortality rate is high even with prompt intervention

Question 56

prevention of neonatal isoerythrolysis

Answer 56

* 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

Question 57

what to do after kittens born to mismatched blood type mom

Answer 57

Kitten should be removed from the dam and transfused if necessary ◦ Can use washed type B blood or cross-match blood

Question 58

congenitive disorders; excess vitamin A

Answer 58

midline defects

Question 59

congenitive disorders; lack of vitamin D

Answer 59

tooth and bone abnormalities

Question 60

congenitive disorders; feline parvovirus

Answer 60

cerebellar hyperplasia

Question 61

congenitive disorders; corticosteroids

Answer 61

cleft palate when given at a certain stage of gestation

Question 62

what other congenitive disorders to look out for

Answer 62

◦ Hare lip, umbilical hernia, anal atresia, skull disorders (open fontanel)

Question 63

different nutrition for neonates is important if:

Answer 63

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

Question 64

how often should neonates be fed

Answer 64

◦ 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