VETN 227B: Neonatal Care

What does peripaturient care mean?

The care that occurs during the time around birth

What does altricial mean?

Completely helpless - can’t do anything on their own

Ex: Pups/kittens

What does precocious mean?

Independent after birth

Ex: Foals/calves + guinea pigs

What should you immediately do after a baby gets delivered?

1. Make them breathe* - very first thing

2. Remove fetal membranes, stimulate them and dry/rub them so they get warm

3. Make them cry** = they’re breathing

What are the other ways to make neonates breathe after birth?

1. Aspirate fetal fluids using bulb syringe

2. Provide ventilatory support using positive pressure (blowing into their mouth) or by using the Jen Chung acupunture point

3. Drugs - put Doxapram 1-2 drops under tongue (not really proven)

What else should you do postnatal when a baby animal is born?

1. Cut off the umbilical cord, suture (preferably absorbable), then spray with iodine

2. Warm the animal by drying/rubbing or put in incubatory at 86-90F

3. If poorly responsive, put 20% glucose on tongue

4. Reunite with mother/dam ASAP* → for colostrum

What should their vitals be at week 1/day 1?

1. Temp - 96-97F

2. RR - 8-18 rpm (day 1)

3. HR - 120-150 bpm (day 1)

What should their vitals be later on (2-4 weeks after)?

1. Temp - 97-100F

2. RR - 15-35 rpm (after)

3. HR - 180-220 bpm (to 4 weks)

What factors are apart of the APGAR scoring?

1. HR

2. Respiratory effort

3. Reflex irritability

4. Motility

5. MM color

When doing a PE on the neonate, what should you check first?

1. MM/CRT - should be pale pink and <2 sec

2. Body weight

Why is weight so important when it comes to neonates?

It’s a survival indicator - if they’re losing/gaining the right amount of weight could mean whether they grow up healthy or pass away

What is the expected gain of weight for puppies?

1-2 g/day/454g* (aka anticipated adult weight)

Ex: 50 kgs (anticipated weight)

1-2g/day/50kg

50-100g/day (check later)

What is the expected gain of weight for kittens?

50-100g/wk

Why do neonates not shiver when they’re super young?

Their body is unable to regulate their thermal temperature until around 6 days when their brain develops enough to do it

• Keep them around 95-99F until they can regulate their temp.

What is the mortality rate of neonates during the first 4 weeks of birth?

~9-26% → most usually pass during their first week

How do neonates get compromised immunity?

Incomplete development where they don’t receive colostrum in the first 24 hrs after being born

How do neonates get infection/septicemia?

1. Umbilical infections

2. Prolonged delivery

3. Milk replacers → leads to aspiration

4. Ampicillin use - never use this, leads to resistant bacteria (noscomial infection)

5. Stress

6. Low birth weight

7. Chilling - too cold

What is fading syndrome?

Where neonates are normal at birth but suddenly start to waste away with no definitive cause

What is purulent conjunctivitis?

Pus in the eyelids before they can open

• Needs to be surgically removed

Why is squeezing through the birth canal important for neonates immediately after birth?

When they are squeezed, it stimulates them to breathe and get fluid out of their lungs → good thing if they are a natural birth

What should the vitals look for the first week or day for neonate dogs/cats?

T - 96-97F

R - 8-18 rpm

P - 120-150 bpm

Generally lower for the first week

What should vitals look like after a few weeks for neonate dogs/cats?

T - 97-100F

R - 15-35 rpm

P - 180-220 bpm

Starts to get higher to normal after a few weeks

What should a puppy’s body weight be?

Variable based on breed, size, etc.

What should a kitten’s weight be?

80-140g

When looking at the face while doing a PE on a dog/cat neonate, what are things you can notice?

1. Head/oral cavity - can have a clef palate or lip → can’t create - pressure in mouth, hard to deal with

2. Ear canals - usually closed 6-14 days

3. Eyes - lids separate 5-14 days, may have PLR but doesn’t mean they can see

When looking at the thorax while doing a PE on a neonate, what are things you might find?

Sinus rhythm

Murmur - PDA hasn’t closed yet

Lung sounds should sound symmetrical

When looking at the abdomen while doing a PE on a neonate, what might you see?

Stomach may be fluid filled but it usually diminishes quickly

When looking at the skin during a neonatal PE, what might you see?

If premature, hair coat may not be fully developed (esp on the bridge of nose)

Check for:

• MM (hydration)

• Wounds

• Parasite signs

How long does it take for the umbilicus to shed off after being cut off?

2-3 days

When doing a neonatal PE, what should you look at for extremities?

1. Anus - make sure it’s open

2. Genitals - make sure they’re in the right spot

3. Nervous system - make sure they have the sucking reflex right when they are born

What is hypospadias?

Another opening that is not the penis/urethra that connects to the bladder

Ex: Another hole to the side of the anus

What is super important to most neonates? (has to do with environment)

They need to be kept warm until they can regulate their temperature

When looking at bloodwork for neonate dogs and cats, what do you usually see? (CBC wise)

• Physiological anemia (for 4-6wks) - more plasma, less RBC

• Blood chem is different (more on another question)

When looking at a blood chemistry for a neonate dogs/cat, what do you see?

Increase in alk. phosphate, phosphorus - normal for neonates

Dec. in albumin, globulin, cholesterol, and BUN

Why are some of the bloodwork, urine tests, and renal function in neonates kinda wonky?

Their liver isn’t at working capacity so they can’t regulate things like albumin, globulin, cholesterol

Their kidneys also aren’t working so BUN will be low, USG in urine will be low, and there might be glucose in urine

GFR (glomerular filtration rate) will be low

What are some reasons why puppies/kittens see the vet at 0-12weeks old?

Illness → congenital, nutritional, low birth weight, trauma, neonatal isoerythrolysis, infectious disease

If they’ve become orphaned

How do kittens/puppies get compromised immunity or incomplete development of immune system?

If they didn’t get colostrum in the first 24hrs

How do you treat kittens with compromised immunity?

Give them adult serum (not dam serum) of 150mL/kg SQ/IP

How do you treat puppies with compromised immunity?

Give them adult serum (not mom serum) at 40 mL/kg orally or parenteral (injection)

What could cause infection/septicemia in neonate kittens/puppies?

Umbilical infection, prolonged delivery, if they use milk replacers (could aspirate on it), ampicillin use (can create resistant bacteria), stress, low birth weight, too cold

What are clinical signs of infection in neonate kittens/puppies?

Loss in weight, failure to nurse, hematuria, diarrhea, abnormal crying, distended abdomen, pain, slough extremities (check MM), sudden death

What are some health concerns of a neonate puppy/kitten?

• Infection/septicemia

• Herpes virus (100% morality)

• Malnutrition

• Fading syndrome

• Purulent conjunctivitis

What is the best antimicrobial to use while nursing a neonate?

Ceftiofur/Naxcel (whatever the brand name is)

What is unique about a neonate’s glucose requirements?

2-4x requirement of an adult → they need a lot more glucose

If a neonate kitten/puppy was orphaned, what are the basic requirements?

• Warm environment

• Regular feeding (q4hrs)

• Stimulate elimination → so they can urinate/release meconium

When should you NOT feed a neonate puppy/kitten?

If they’re hypothermic

What are the methods to hand feeding a neonate puppy/kitten?

1. nipple bottle

2. Dose syringe

3. Feeding tube

When hand feeding a neonate, what should you always do to the food/milk?

Warm it to ~100F (do not have it room temp or cold)

When using a nipple bottle for hand feeding neonates, what should you be careful of?

Don’t have air in the bottle (can lead to air colon), don’t squeeze the bottle (can lead to aspiration)

What is the general size for a feeding tube for a neonate puppy/kitten?

5-8F

How do you make sure you’re in the stomach and not the lung when placing a feeding tube?

By marking the tube from the tip of the nose to the last rib and making sure you don’t go past that mark when you intubate

If you hit a blockage → you might be in the trachea

When should neonate puppies/kittens start eating solid food?

3-4 weeks

• We want to wean them ASAP

After feeding a neonate puppy/kitten, what should we do?

Stimulate elimination by swabbing anogenital area - like how a cat would lick their baby

What is a high risk mare?

A mare that has a problem

What are some factors that might make a high risk mare?

• Advanced age

• Poor health

• Perineal conformation

• Previous dystocia

• Prolonged transport - late gestation

• If they’ve had twins

What does perineal conformation mean?

How the perineum area should look like/conform to → it should be vertical with the anus and vulva directly in line

• if it’s slanted, can lead to infection

What is placentitis and what can it lead to?

Infection of the placenta (can come through the vagina, uterus, then placenta) and can cause dripping milk

What is dripping milk?

When a mare has placentitis and their teats start to produce milk, even though she’s not close to giving birth

What is waxing?

When a mare’s teats start to get engorged and start dripping milk, this is a sign they are about to give birth

How long is a horse’s gestation time?

~340 days (11months)

When do mares typically give birth?

For some reason, at night

What are ways to see when a mare is about to give birth?

• Udder engorgement → waxing

• Colostral calcium increases - >10-12mmol/dL

• Visual monitoring - behavior changes

How many stages are there to labor in a mare?

3

What does the first stage of labor for a mare consist of?

Behavior changes - they start pawing at the ground

They start sweating around their shoulders

What does the second stage of labor for a mare consist of?

Fetal membranes rupture AKA “water breaks”

• Water consists of - amniotic and renal fluids

Fetal deliver is in ~ 30 mins

What does the third stage of labor for a mare consist of?

Placental passage - placenta comes out

A high risk mare creates…

A high risk foal

What are some factors to being a high risk foal?

• If they’re a twin

• Prematurity - <320 days

• Dysmaturity

• Post maturity

• FPT* - failure of passive transfer

What are signs of prematurity in a foal?

Low weight, weakness, delayed standing, domed forehead*, tendon laxity, angular limb deformity, flappy ears, soft lips

What is dysmaturity in foals?

They come after their expected date and are large - maturity is abnormal for their age

• Large but have premature characteristics

What is postmaturity in a foal?

They spend longer in the uterus and come out large, but thin

• Their incisors have already erupted

What is FPT?

Failure of passive transfer - no nursing = no immunity

How does a high risk foal survive in general?

Early recognition of signs

What are classic signs of high risk foals?

Lethargy, depression, no suckle reflex, less appetite, increased recumbency/wanting to sleep

When should normal foals be able to suckle?

w/in 20 mins

When should normal foals be able to stand?

w/in 1-2hrs

When should normal foals be able to nurse?

w/in 2-3hrs

When should normal foals be able to urinate?

w/in 10-12hrs

When should normal foals be able to pass meconium?

Within a few hours or before 24 hrs

• if not, they may need an enema

What is meconium?

1st GI material that’s in a neonate (not feces!)

How many times should a mare be able to nurse?

~7x/hr

When foals stand up, are their respirations strong and regular?

Yes