Pediatrics Flashcards
how often should the healthy neonate nurse?
-every 2-3 hours
most important consideration to determine a healthy neonate
-gaining weight
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
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
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
if hand rearing a neonate, at what temp should you not feed?
Should not be fed if body temperature is below 36C
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
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
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
4 ‘hypos’ of fading syndrome
Hypothermia
Hypovolemia
Hypoglycemia
Hypoxemia
most important viral cause of diarrhea in older pups and kittens
parvovirus
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
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)
Signs of a sick neonate include:
Weak, restless/vocalizing persistently, being ignored, isolated, not gaining weight
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
when do physiologic processes mature in the juvenile?
by 8-12 weeks
dam considerations for neonatal health
General health
Age
Nutrition
Infections
Parasitism
Sanitation
Genetic factors
parturition factors for neonatal health
Normal birth weight
Hypoxia
Prolonged labor
Dystocia
Early placental separation
indications for neonatal physical exam
Post C-section
Preventative health care program
Cosmetic procedures
Sick
shape of a healthy neonate, and refleces
“Fat and sleek”
>Round abdomens, elastic skin (pups > kittens)
Robust & strong vitality reflexes
>Strong rooting, suckling, righting
neonatal healthy responses to test in PE
Righting
Responsive to noxious tactile stimuli
Responsive to odors
5 signs of the sick neonate
- weak (limp, poor reflexes)
- Restless, persistent vocalization
- being ignored
- isolation
- poor weight gain
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
where externally on the neonate can we see signs of sepsis
Ventral abdomen - sepsis
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)
