Pediatrics Flashcards by Mark Sunarich

how often should the healthy neonate nurse?

-every 2-3 hours

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most important consideration to determine a healthy neonate

-gaining weight

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normal neonate growth rate, and what it means if growth is not acheived

Double weight in 1 - 2 weeks
>Failure to grow is a negative sign

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if a neonate is being hand-reared, when should their weight double by? How often should they be wieghed?

Should double their birth weight by 7-10 days of age
-Neonates should be weighed daily until at least 3 weeks of age to ensure proper weight gain

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how do the fluid requirements of neonates differ from other life stages and why?

Fluid requirements are higher in neonates
-Higher body water content
-Immature renal functions
-Rapid fluid turnover

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if hand rearing a neonate, at what temp should you not feed?

Should not be fed if body temperature is below 36C

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what happens if you feed a neonate that is hypothermic (>36C)?

hypothermia
>ileus, gut stand still
>previously ingested milk ferments
>bloat
>dysplnea, increased pressure on thorax
>neonate in pain, distress, air is swallowed
>More bloat……etc.
>regurgitation > aspiration pneumonia

> note that tube or force feed can also cause aspiration pneumonia here

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what are the keys to resuscitation post c-section

Be prepared
>all about BREATHING AND WARMTH

-clear nose, mouth
-keep head tilted down
-brisk rubbing with towel all over > stimulates respiration, keeps neonate warm

> Should be crying and pink <2 min

> tie off umbilicus and bad with iodine

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what is fading syndrome and what are risk factors?

-Born apparently healthy
-Stop nursing, weaken, die
>No specific clinical signs or obvious cause

Risk factors:
-dystocia, low birth weight

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4 ‘hypos’ of fading syndrome

Hypothermia
Hypovolemia
Hypoglycemia
Hypoxemia

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most important viral cause of diarrhea in older pups and kittens

parvovirus

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what is neonatal isoerythrolysis? when does it occur? how do we deal with this?

Type A or AB kittens born to type B queens
-Maternal anti-A antibodies in colostrum
-Sudden death, fading, tail tip necrosis
-Blood-type parents
-Remove kittens at risk for 24 hours

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What defines neonate vs infant vs juvenile

Neonate: Birth – 10-14 days
Infant: 2-5/6 weeks (pre-weaning)
Juvenile: Post-weaning – 6 months (puberty)

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Signs of a sick neonate include:

Weak, restless/vocalizing persistently, being ignored, isolated, not gaining weight

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Tube feeding is necessary during hand rearing if:

-when should we not tube feed?

-If the neonate will not nurse from the bottle, or isn’t gaining the expected weight
-Kittens/puppies should not be tube fed if their temperature is below 36C

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when do physiologic processes mature in the juvenile?

by 8-12 weeks

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dam considerations for neonatal health

General health
Age
Nutrition
Infections
Parasitism
Sanitation
Genetic factors

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parturition factors for neonatal health

Normal birth weight
Hypoxia

Prolonged labor
Dystocia
Early placental separation

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indications for neonatal physical exam

Post C-section
Preventative health care program
Cosmetic procedures
Sick

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shape of a healthy neonate, and refleces

“Fat and sleek”
>Round abdomens, elastic skin (pups > kittens)

Robust & strong vitality reflexes
>Strong rooting, suckling, righting

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neonatal healthy responses to test in PE

Righting
Responsive to noxious tactile stimuli
Responsive to odors

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5 signs of the sick neonate

weak (limp, poor reflexes)
Restless, persistent vocalization
being ignored
isolation
poor weight gain

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wht do we need to watch out for in terms of neonate hydration and what can we look at to observe this

-Prone to dehydration and volume overload
-Mucous membranes
>Tongue should be light pink and moist

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where externally on the neonate can we see signs of sepsis

Ventral abdomen - sepsis

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how often to weigh neonate

2x daily

neonates get which relfex at 6 days to help with temp regulation - what are they considered before this?

shivering at 6 days -before this, poikilothermic

normal heart rate for neonate

>200

hypothermia or hypoxia leads to what heart condition in the neonate

bradycardia

when will neonate eyes and ears open, and when will menace, PLR, and hearing mature?

Open 5 – 14 days Menace, PLR, hearing mature by 4 weeks

what does normal neonate skin look like? what are 3 common conditions to look out for?

Normally shiny Focal alopecia: prematurity, grooming Erythema: heat stress, sepsis Ulcers: septic emboli -Bleeding Petechiation: canine alphaherpesvirus Ecchymoses: hypoprothrombinemia Lice

common issues of neonate oral cavity

Cleft palate, short soft palate Lingual ulcers and bleeding

common problems of neonate abdomen

Distension (gas) Pain (gas, canine alphaherpesvirus)

common problems of neonate anus

Erythematous (diarrhea) Imperforate (constipation)

firm stools for neonate means? liquid?

-firm = dehydration -Liquid stool abnormal: >Green and foamy >Bright yellow (canine alphaherpesvirus) >Blood-tinged (sepsis) >Bocavirus (CPV-1, minute virus of canines)

why hand rear?

Maternal weakness Orphan >Stray cats Agalactia Foster

why must warmth be provided to any neonate? rule of thumb for housing temp?

cannot regulate thier body temp <2 weeks of age Rule of thumb: Back of hand should be held to hottest area of housing for at least 2 minutes >If too uncomfortable, it is too hot for the neonates

rearing area temp and humidity for neonates?

Temperature (32 °C 1st week) Humidity (55 – 65%) Cleanliness

hand rearing - what do we feed and when?

-For first 3-4 weeks of life, milk replacers will be only source of nutrition -Thereafter, weaned onto soft gruel >Supplemented with milk replacer

temp of milk replacer when it is fed

body temp - 37.8

if using powedered ,ilk replacer, how much should you make in one batch?

If made from powder, only amount used in 24 hours should be made >Leftover discarded

feeding schedule for heand reared neonate

1st week q2 – 3h 2nd week q4h 3rd – 4th week q6h

options for hand feeding neonate and when to use

Nursing bottle >Strong suckling reflex Stomach tube (gavage) >Weak reflex, faster

Main source of energy during first weeks of life, for puppies and kittens:

Puppies: fat Kittens: protein

proper positioning for bottle feeding

Forward and upward stretched head and neck

tube feeding for neonate necessary when?

-If neonate will not nurse from bottle -Neonate doesn’t gain the expected weight due to illness or malformation

do not use feeding tube if temp less than:

< 35.5C

feeding tube technique and stomach volume of neonate

Clean and dry feeding tube gently inserted into mouth while holding patient upright Negative pressure Check residual volume Stomach volume 50 mL/kg Tube withdrawal and burp >Tube pinched and removed quickly

how to stimulate neonaate pooping

Stimulate anogenital region with warm, moistened cotton ball/towel

COMMON PITFALLS of hand rearing nutrition

Over-feeding >Diarrhea or constipation Underfeeding >Dehydration >Lack of weight gain/weight loss >Lethargy >Malnutrition

weaning food schedule - when semisolid food, when solid?

>Can begin eating semisolid food as early as 3-4 weeks >By 5-6 weeks, puppies/kittens should be able to eat solid food formulated for their age group and size

after C-section: If heart beating and not breathing, what to do?

keep warming and stimulating -Oxygen face mask -GV 26 (Jen Chung) acupuncture point >25ga needle, repeated “pecking” -Tiny endotracheal tube and gentle inflation >1-2mm tube, or 18g IV catheter -Doxapram only if oxygenated >Inject umbilical vein (not sublingual)

when do we do CPR for neonate after C section

CPR if not breathing & no heart beat

treatment for fading syndrome

1) Consider isolating from mother and litter (not if dam very attentive) 2) Treat four Hypos

How to treat hypoglycemia?

dextrose by tube, or IV/IO

antibiotic for neonate sepsis?

ampicillin, or other

how to relieve abdominal distension in neonate

Confirm gas with radiograph Stomach tube Rectal tube Trocharize with hypodermic needle

what to give to fading kittne

5 g L-thyroxine once daily (25 g tabs)

what dam condition gives pups increased risk of fading syndrome

hypothyroid

prognosis and mortality for fading syndrome

Pre-weaning mortality rates 10 – 30% >50% in first 3 days >65% in first week Rates lower with prompt therapy Prognosis poor for solitary sick animal in litter, especially if low birth weight Can “bounce back” from trauma

Systemic neonatal disorders

Fading Syndrome Pneumonia -Viral (adenovirus, herpes) -Bacterial Diarrhea

Juvenile hypoglycemia: risk factors

Toy breeds Small muscle mass Poor liver function Hypothermia Triggers DDx Portosystemic shunt

Hyperlipidemia of kittens: when does it occur and what are risk factors

3 – 8 weeks of age Low weight, anemia, heavy flea burden Analogous to hepatic lipidosis >Ecto/endoparasite control >Nutritional support (high protein, low fat)