Small Animal Pediatrics

Visit the link below to download the full version of this book:

https://medipdf.com/product/small-animal-pediatrics/

Click Download Now

Chapter 1 Prenatal Care of the Bitch and Queen 5

congenital edema involves generalized subcutaneous edema Nutritional components have caused congenital defects.
and varying amounts of fluid in other body cavities (Figure Excessive vitamin A between days 17 and 22 has been
1-1). The condition is known to be heritable likely as a reces- reported to result in cleft palates, kinked tails, and deformed
sive trait. Many of the anasarcous puppies also are afflicted auricles in kittens. Excess vitamin D has been linked with
with congenital heart defects. tissue calcinosis, premature closure of fontanelles, enamel
Cleft palates are common in all of the brachycephalic hypoplasia, and supravalvular stenosis.
breeds (Figures 1-2 and 1-3). Cleft palates can be caused by Congenital malformations can best be evaluated by
genetic traits or by teratogenetic agents. Both griseofulvin careful necropsy of all nonsurviving puppies or kittens with
and corticosteroids have been implicated as teratogens that the goal of eliminating the cause of such defects (see Chapter
can cause cleft palate. Even aspirin has been demonstrated 31). There are several drugs that are contraindicated
to cause cleft palates. In general, all drugs should be avoided during pregnancy because they are known to cause birth
in the pregnant bitch or queen, including all live virus vac- defects (Box 1-5). For an explanation of the reproductive
cines, unless they are necessary to maintain the welfare of effect or for a complete list of drugs that are safe for use
the mother and the drug is reported to be safe during during pregnancy, see Chapter 27 (Table 27-4). Clinicians
pregnancy. should obtain a good drug history, including the use of
topical, herbal, and other alternative modalities (Box 1-6).

THE PREGNANCY CONFIRMATION VISIT

The bitch should have her pregnancy confirmed 25 to 30
days after her first breeding (Table 1-4). In lean relaxed
bitches, it may be possible to detect discrete swellings in the
uterus as early as 21 days after breeding. However, it is not
possible to use palpation to differentiate uterine swellings

BOX 1-5 Drugs known to cause congenital

malformations or embryotoxicity

Altrenogest Griseofulvin
Aspirin Misoprostol
Ciprofloxacin Mitotane
Corticosteroids Oxytetracycline
Diethylstilbestrol Pentobarbital
Doxycycline Stanozolol
Enrofloxacin Streptomycin
Estradiol cypionate Testosterone
Figure 1-1 Anasarca. This miniature bulldog puppy has diffuse Excess vitamin A Tetracycline
subcutaneous edema typically associated with anasarca. Excess vitamin D Warfarin
Gold

Figure 1-2 Cleft palate. Note the cleft extending the length of Figure 1-3 Cleft palate with harelip. Newborn Boston Terrier
the palate. This 3-day-old Samoyed puppy presented with puppy demonstrating both a rostral cleft in the palate and a
failure to gain weight and dyspnea. harelip defect.
6 SECTION I: GENERAL CONSIDERATIONS

BOX 1-6 Topical therapies to avoid

during pregnancy

Carbaryl
Dexamethasone sodium phosphate ophthalmic
Genesis topical spray
Mometamax FETUS 29 DAYS
Ophthalmics containing corticosteroids
Panolog cream
Pennyroyal
Rotenone
St. John’s Wort
TriTop ointment
Figure 1-4 Pregnancy ultrasound shows a normal dog fetus at
day 29 of gestation.

TABLE 1-4 Pregnancy diagnostics in the bitch

Appropriate/recommended PYOMETRA
Diagnostic type time period

Abdominal palpation • 23-30 days after breeding

• 25-30 days after LH surge
• Not after 30 days
Ultrasonography • 25 days after LH surge till
parturition
Radiography • 45 days after breeding
• Improved reliability closer
to term
Relaxin • Hormone level is
measured by
radioimmunoassay or Figure 1-5 Pyometra. The ultrasound shows a fluid-filled
ELISA techniques uterus. Note the difference in echogenicity compared to the
• Not as reliable as normal fetus in Figure 1-4. It is important to differentiate pathol-
ultrasonography ogy from normal pregnancy.

LH, Luteinizing hormone; ELISA, enzyme-linked immunosorbent assay.

to be accompanied by low volume of embryonic fluid, ces-
sation of fetal heart beat in the smaller sacs, shrinkage, and
associated with uterine pathology (Figures 1-4 and 1-5) ultimately resorption. Ultrasound has not been proved reli-
from normal uterine development associated with preg- able for determination of litter size. Determination of fetal
nancy. After day 35, the uterine swellings enlarge, resulting age involves multiple measurements of the biparietal or
in a confluence, making pregnancy palpation even more trunk diameter and must take into consideration differences
unreliable. relative to breed and litter size.
Real-time ultrasonography is valuable in early pregnancy Embryonic vesicles may be detected earlier in the queen
diagnosis, as well as throughout the second half of gestation than in the bitch (Table 1-5). Ultrasonographic pregnancy
whenever there is a question of fetal viability or fetal loss. diagnosis is accurate in the queen as early as 11 to 16 days
Ultrasonography in the bitch is accurate for pregnancy diag- after breeding. Fetal heartbeats may be detected as early as
nosis in the hands of an experienced ultrasonographer using day 16. Embryonic vesicles closest to the uterine bifurcation
quality equipment as early as 19 to 21 days post-LH peak are detected earliest, and early examination may miss some
in the bitch. When the LH peak is known, pregnancy diag- fetuses. The ultrasound should be repeated 5 to 7 days later
nosis in the bitch is very accurate after days 21 to 23. If the if no fetal vesicles are seen. Ultrasound in the queen can be
LH peak is unknown, ultrasonography for pregnancy detec- used to detect fetal loss and may be used in an attempt to
tion should be performed at approximately 30 days after the estimate fetal age.
last known breeding (see Figure 1-4). Fetal heartbeats are Hormonal diagnosis of pregnancy varies with species. In
first detected 23 to 25 days after the LH peak or 16 days the bitch, progesterone elevations are not different whether
after the onset of cytologic diestrus. In addition to pregnancy a bitch is or is not pregnant. Progesterone levels, however,
diagnosis, ultrasonography can be used to identify fetal loss. can be used to confirm ovulation failure. In the queen, pro-
This author has observed disparity between the sizes of ges- gesterone levels may be used 40 days after breeding to
tational sacs in some pregnancies. This size disparity appears differentiate pseudopregnancy from pregnancy. In the
Chapter 1 Prenatal Care of the Bitch and Queen 7

pseudopregnant queen, progesterone declines to baseline changes throughout pregnancy, and both the bitch and the
levels by day 40 after breeding but remains at 1 ng/ml or queen will experience a gradual decline in hematocrit associ-
above in pregnant queens. Prolactin levels increase in both ated with increased plasma volume (Tables 1-6 and 1-7).
the pregnant bitch and the pregnant queen; however, a com- Pregnancy may be accompanied by toxemia in bitches car-
mercial test is not available. Relaxin is the only reported rying large litters. Ketosis can develop in bitches not meeting
hormone that is pregnancy-specific in carnivores and is pro- the nutritional demands of pregnancy, and a negative energy
duced by the fetoplacental unit. Relaxin is best measured by balance can develop. Anorexia in late pregnancy must be
radioimmunoassay or enzyme-linked immunosorbent assay corrected by force feeding or parenteral nutrition.
(ELISA) techniques. An in-clinic test (ReproCHEK, Syn- The owner should be questioned about any changes in
biotics; www.synbiotics.com) has been developed but is not behavior or appetite, increases or decreases in water con-
as reliable as ultrasonography. sumption, extent of mammary development, and the pres-
At this visit, the physical examination should be repeated. ence of any vaginal discharge. If the bitch or queen is found
The body condition of the bitch or queen should be assessed, to be nonpregnant at this visit, a diagnostic workup for
and recommendations made for adjustments as needed. If conception failure should be discussed. This is a good time
the bitch or queen has previously been on a maintenance to remind the owner to avoid exposure to any infectious
diet, she should be switched to a ration suitable for preg- disease. The bitch or queen should remain in the home,
nancy and lactation. In cases where the bitch or queen is kennel, or cattery environment and should not share housing
underweight and anorectic, a balanced multivitamin, such as or exercise areas with animals still in competition or training.
Pet-Tabs, should be considered. There are hematologic This includes shared areas for exercise even if direct contact
is prevented.
There are numerous viral and bacterial diseases that have
potential risks for the pregnant animal. Training classes and
TABLE 1-5 Pregnancy diagnostics in the queen competitive field events should be discontinued because the
Appropriate/recommended effect of stress on the bitch can be significant. With maternal
Diagnostic type time period stress, there is increased adrenaline secretion, decreased
uterine and placental blood flow, decreased oxygen to the
Abdominal palpation • 15 days after breeding fetus, and increased fetal adrenocorticotropic hormone
Ultrasonography • 11 days after breeding:
(ACTH).
embryonic vesicle
• 16-25 days after
breeding: fetal heartbeat THE PRENATAL EXAMINATION
• Effective till term
Radiography • 35 days after breeding Before term the bitch or queen should be introduced to her
• Progressive increase in delivery area. This area should be safe and quiet and provide
fetal calcification the privacy and comfort needed for the dam to become
acclimated and ready for parturition. The bitch should be

TABLE 1-6 Effects of pregnancy on canine hematology

Gestation 2 weeks 4 weeks 6 weeks 8 weeks Term

RBC (million/µl) 8.85 7.48 6.73 6.20 4.58

PCV (%) 53 47 44 37 32
Hgb (gm/dl) 19.6 16.4 14.7 13.8 11.0
WBC (thousands/µl) 12.0 12.2 15.7 19.0 18.9

RBC, Red blood cells; PCV, packed cell volume; Hgb, hemoglobin; WBC, white blood cells.

TABLE 1-7 Effects of pregnancy on feline hematology

Gestation 1 day 2 weeks 4 weeks 6 weeks 8 weeks Term

RBC (million/µl) 8.0 7.9 7.1 6.7 6.2 6.2

PCV (%) 36.1 37.0 33.0 32.0 28.0 29.0
Hgb (gm/dl) 12.5 12.0 11.0 10.8 9.5 10.0
Reticulocytes (%, includes punctate) 9 11 9 10 20 15

RBC, Red blood cells; PCV, packed cell volume.

8 SECTION I: GENERAL CONSIDERATIONS

introduced to the whelping area and confined to the area pregnancy requires intensive monitoring. Normal fetal heart
where she will whelp at least 1 week before the anticipated rates at term are often greater than 200 beats per minute.
parturition. The queen will often seek a small confined area During the prenatal visit, it is prudent to evaluate the
for parturition. dam’s blood glucose and serum calcium (ionized calcium
The bitch or queen should have a lateral abdominal radio- preferred) levels and packed cell volume. The physical exami-
graph (Figure 1-6) taken 5 to 10 days before the expected nation should include a digital vaginal examination to detect
delivery date to assess the number of fetuses. Radiography any soft tissue obstructions (stricture or masses) and to
is an accurate method for determination of fetal numbers evaluate the vaginal area for excessive edema. Any vaginal
but can underestimate the litter size in very large litters. discharge warrants vaginoscopy, using either a human sig-
Radiography will also allow the assessment of the fetal skel- moidoscope (Figure 1-8) or a rigid endoscope (Figure 1-9)
eton for signs of fetal death (i.e., collapse of the fetal skeleton with a video monitor to assess cervical patency and the pres-
or gas within the uterus). Radiography does not truly assess ence of fetal membranes. The client should be given verbal
the presentation of the fetus because of the mobility of the and written instructions on the management of parturition
uterine horns. Ultrasonography is a better diagnostic tool for and should be encouraged to inform the clinician of any
the assessment of fetal health since it allows examination of change in rectal temperature (Boxes 1-7 and 1-8). The bitch’s
the fetal heart rate, the amount of allantoic fluid, fetal move-
ment, and some fetal abnormalities such as abdominal wall
defects (Figure 1-7). Fetal heart rates that are below 130
beats per minute indicate poor puppy viability, and the

Figure 1-8 A human sigmoidoscope can be used for vaginos-

copy to check the status of the cervix or if there is a puppy in
the vaginal canal.

Figure 1-6 The lateral abdominal radiograph can be used to

assess number of fetuses. Six puppies can be seen on this film
of a Labrador retriever bitch taken 6 days before whelping.

PUPPY MOUTH / TONGUE

YAWNING

Figure 1-7 Ultrasound is the best tool for assessing fetal status
and viability. It can be used to assess fetal heart beats, as well Figure 1-9 A Storz rigid endoscope can be used to examine
as movement of the fetus. This ultrasound captured a near-term the cervix and vagina and can also be used for transcervical
puppy yawning. insemination.
Chapter 1 Prenatal Care of the Bitch and Queen 9

BOX 1-7 Complications of whelping

Prolonged gestation Stage I labor

>71 days after breeding Uterine inertia
>65 days after LH peak Collapse of bitch
>57-59 days after diestrus Vomiting
Temperature drop to 99° F (37.2° C) >24 hours Stage II labor
previously Straining continuously for 30 minutes without delivery of
Vaginal discharge a puppy
Mucoid—normal 3 hours intermittent contractions before first puppy
Hemorrhagic—abnormal More than 3 hours between puppies
Green tinged—abnormal
Black—abnormal

LH, Luteinizing hormone.

BOX 1-8 Normal birth in dogs (whelping)

Preparations for Whelping occur in this phase. This stage usually lasts 10 to 30 minutes,
Begin preparations for delivery of puppies before the female but it may range from a few seconds to an hour.
gives birth. Provide a whelping box for the mother to begin
sleeping in to ensure the puppies are born in the area you Obstetric Care
have chosen. This box should be only slightly bigger than the After a pup is delivered, remove all membranes covering the
mother, with sides 6 to 8 inches high to keep the pups from puppy, clean the face, and remove mucus from the mouth
crawling out of the nest. Place the box in a secluded yet and nose. Rub the puppy with a clean towel to dry it and to
familiar area of the home, away from the family traffic, to allow stimulate respiration and circulation. After a few minutes of
the mother solitude. Newspapers make excellent bedding rubbing, the puppy should begin to squirm and cry loudly.
because they can be changed easily, are absorbent, and can The umbilical cord should be tied about an inch from the
be shredded by the mother as she makes her “nest.” If materi- puppy’s body with fine thread and then cut on the side of the
als such as old quilts, blankets, rugs, or towels are used, they knot away from the puppy. Apply a drop of Betadine to the
must be washed frequently. cord end after it is cut.
If you want to know precisely when delivery is near, check
the rectal temperature of the mother twice daily from the 58th Assisting with the Birth
day of pregnancy until labor begins. Normal rectal tempera- If a puppy seems to be lodged in the birth canal and the
ture is between 100.5° F (38° C) and 102° F (38.9° C). mother cannot expel it, rapid assistance is necessary. There
Within 24 hours before the onset of labor, the rectal tempera- may not be time to call the veterinarian and drive to the hos-
ture drops nearly 2 degrees to 99° F (37.2° C) or below. pital. Grasp the puppy with a clean towel and exert steady,
firm traction. Do not jerk or pull suddenly. Traction may have
Labor and Delivery to be applied for as long as 5 minutes. If you cannot remove
Labor in the female dog (bitch) can be divided into three the puppy, call the doctor.
stages. The second and third stages are repeated with the
birth of each puppy. During the first stage, the mother seems Notify the Doctor if any of the
extremely restless and very nervous and often seeks seclu- Following Occur
sion. She may refuse food even if offered her favorite treats. • A puppy is lodged in the birth canal and cannot be
This stage may last 6 to 24 hours. This is a good time to exer- removed.
cise the mother to allow her to urinate and defecate. In the • There is strong, persistent labor for 30 minutes without
second stage, uterine contractions and expulsion of the delivery of a pup.
puppies begin. Usually, a small greenish sac of fluid protrudes • There is weak, intermittent labor for 3 hours without
from the vulva, followed by the puppy and its attached pla- delivery of any puppies.
centa. The normal presentation of the puppy is nose first, • It has been more than 3 hours since the delivery of the
stomach down (“diving” position). About one-third of all last pup, and it is probable that more puppies are still
puppies, however, are born hindquarters first. This presenta- inside.
tion is considered normal in the dog. After delivery, the mother • There is a greenish-black vaginal discharge and no labor
opens the sac, cleans off the pup, and severs the umbilical or puppies within 3 to 4 hours. The greenish-black color
cord. You may have to perform these functions for the mother is normal, but the discharge should be followed very
(see Obstetric Care). Make sure the sac is removed from the soon by delivery of the pups.
puppy immediately if it is unbroken during delivery. The third • The pregnancy lasts more than 65 days.
stage of labor is the resting stage, which follows delivery of • It has been 24 hours since the drop in rectal temperature
each puppy. Mild contractions and delivery of the afterbirth and there are no signs of labor.
10 SECTION I: GENERAL CONSIDERATIONS

temperature commonly drops to below 99° F (37.2° C) information if the clinician will be providing after-hours
within 24 hours of initiation of parturition. The queen may care or contact information for appropriate emergency care.
experience a similar decrease in rectal temperature, although
it is seldom reported by the owner. The temperature drop
follows the decrease in progesterone at the end of pregnancy. SUGGESTED READINGS
During late pregnancy, the pattern of uterine electrical activ- Johnson CA: Reproduction and periparturient care, Vet Clin North Am
ity changes, which correlates with the decrease in plasma Small Anim Pract 16(3):417-605, 1986.
Johnston SD, Root Kustritz MV, Olson PNS: Canine and feline theriogenol-
progesterone. This suggests that progesterone plays an ogy, Philadelphia, 2001, Saunders/Elsevier.
important role in the process of parturition in the bitch. The Lee MP: The whelping and rearing of puppies: a complete and practical guide,
client should be counseled to seek veterinary attention if Neptune City, NJ, 2003, TFH Publications.
Simpson GM, England GCW, Harvey MJ: Manual of small animal repro-
labor is not initiated within 24 hours of the decrease in rectal duction and neonatology, Gloucester, 1998, British Small Animal Veteri-
temperature. The client should be given after-hours contact nary Association.
 BIRTH AND THE FIRST 24 HOURS

C H A P T E R 2
Valeria Rickard

There are significant physiologic differences between fetuses but are not visible to the human eye. These contractions can,
and neonates. Puppies and kittens are born much less mature however, be detected by the Whelp Wise service.
than newborns of many other domestic species and thus are Stage II usually lasts 6 to 12 hours. The body temperature
more dependent on care during the first few days of life. The rises and returns to its normal level. Internally, the first fetus
treatment of newborn puppies and kittens can be quite chal- moves toward the pelvic canal. On entering the pelvic canal,
lenging to the practicing veterinarian because of the neo- the allantochorionic membrane of the placenta can rupture
nate’s small size and immature organ function. Therefore it and a discharge of clear fluid may be noted. Uterine contrac-
is very important for the veterinarian to understand the tions will increase in force and will be outwardly visible.
unique physiology of the neonate. These uterine contractions will ultimately result in the expul-
sion of the fetus.
Stage III is expulsion of the placenta, usually happening
PARTURITION
immediately after the successful delivery of the fetus.
To avoid a multitude of complications and to best prepare Throughout the birth process, stages II and III will alternate
for the event, it is very important to accurately predict when until all fetuses have been delivered.
the parturition will occur. There are many different ways to Dams/queens should be allowed to resuscitate their new-
make this prediction, and some ways are more accurate than borns. Whenever possible, the following steps should be
others (Box 2-1). performed by the mother:
• Licking of fetal membranes away from the mouth and
nose
NATURAL BIRTH
• Biting off the umbilical cord and eating the placenta
Normal labor can be broken out into three distinct stages. • Licking and nuzzling the newborn to stimulate it, encour-
For the descriptions of the stages of labor, the term usually age it to nurse, and move it closer to her to maintain its
will be used here to represent a normal range of values. It body temperature
should be noted that these ranges may not be exact for every Intervention should only happen if the dam/queen is not
bitch or queen and for every circumstance. showing any interest in the newborn during the first 30 to
Stage I usually lasts 12 to 24 hours. Clinically, bitches/ 60 seconds after delivery. The action of nursing of puppies/
queens may be restless and actively panting, scratching, and kittens releases natural oxytocin and helps strengthen con-
digging, whereas other bitches/queens are quiet. For the tractions and delivery of the subsequent fetuses.
most part, on the day of delivery, they will not eat. The bitch/
queen’s temperature will drop to 98° F (36.7° C) and remain Assistance in Natural Delivery
at that low level throughout this stage. Queens may vocalize, If the mother is not performing the previously mentioned
turn around in circles, and lick themselves constantly. Inter- duties satisfactorily, then human assistance is required. Fetal
nally, cervical dilation starts. Since the cervical opening is at membranes should be removed by wiping the neonate with
the level of the lumbar vertebrae in dogs, it cannot be pal- a warm towel and clearing the nose and mouth area first. A
pated but may be visualized through a rigid cystourethro- bulb syringe or a DeLee’s mucus trap suctioning device can
scope. Weak uterine contractions will occur during this stage be used to suction out both nostrils and mouth. A gentle

11
12 SECTION I: GENERAL CONSIDERATIONS

BOX 2-1 Methods for predicting delivery date BOX 2-2 Clinical signs possibly associated
with dystocia
• One timing method: Stating parturition will occur 63
days (±24 hours) from the day of ovulation (measured • Green/brownish-red discharge is noted, and the first
progesterone levels at 4 to 8 ng/ml). puppy is not produced within 1 hour.
• Another timing method: Stating parturition will occur • Weak contractions are exhibited for more than 3
65 days from the LH surge. hours.
• Another timing method: Stating parturition will occur • Strong, sustained contractions without the expulsion of
57 days from end of diestrus (confirmed by cytology). the fetus within 30 minutes.
• Measuring a drop in serum progesterone levels to • More than 3 hours elapse since the last puppy/kitten
<2 ng/ml, indicating parturition will occur in 12 to was born and more fetuses remain inside.
24 hours. • The dam/queen has been in stage II labor for more
• Measuring a temperature drop to 98° F (36.7° C), than 12 hours.
indicating parturition will occur anywhere between 8
and 24 hours.
• Using of a Whelp Wise monitoring system (www.
whelpwise.com) that will pick up changes in uterine
activity. round openings cut out for ventilation. Also longitudinal
• Examining of radiographic changes that indicate a slits should be made in the lid so that the new mother can
calcification of the digits; used in conjunction with smell and hear her offspring, as well as see them move. It
ultrasonographic measurements. will help with the desensitization process. The offspring
should be removed from the container for supervised and
LH, Luteinizing hormone. assisted nursing. Usually only 48 to 72 hours are needed to
calm new mothers.
In normal labor, the female may show weak or infrequent
contractions for up to 2 and at the most 4 hours before
rocking of the newborn in a head-down position (while head giving birth to the first fetus. If the female is showing strong
and neck are supported) can assist with the removal of the and sustained contractions and a puppy or a kitten is not
remaining fluid from the chest/trachea. Swinging of the produced within 30 minutes, a possible obstruction may exist
newborns is no longer advocated because of potential cere- and immediate veterinary advice should be sought.
bral hemorrhage from concussion. The dam/queen should be presented for veterinary exami-
The umbilical cord should first be clamped about 1 4 -inch nation immediately if any evidence of delivery problems is
away from the body wall, then tied off with a piece of suture, noted (Box 2-2).
and finally dabbed with either a chlorhexidine or Betadine Fetal viability and distress is best diagnosed with the use
solution. Once the neonate is dry and breathing well, it can of ultrasound. Since the normal fetal heart rates are between
be put with the dam/queen. A healthy neonate should 180 to 220 beats per minute (bpm), a heart rate below
actively search for the dam’s teat and should start suckling 180 bpm indicates fetal distress. If the fetal heart rate falls
almost immediately. below 150 bpm, an emergency is indicated and requires an
Care should be taken in case the dam/queen rejects the immediate cesarean section (C-section).
neonate and attempts to bite it. In this situation, a light
tranquilization with acepromazine (0.01 to 0.02 mg/kg)
CESAREAN SECTION
might be necessary initially and the dam/queen should not
be left alone with the offspring until the problem of rejection If a C-section is deemed necessary, several aspects of this
is overcome. Sometimes, rubbing placental fluids on the procedure should be considered to maximize success and
neonate may help the mother to recognize it as her own. A ultimate survivability of the fetuses. The primary consider-
few drops of oxytocin may be applied topically to her nostrils ations and focus should be placed on preparation, choice
to assist in mothering behavior. of anesthesia, careful use of approved drugs, and speed of
At times, injections (Cal-Pho-Sol 1 cc/10 lb subcutane- execution.
ous [SC]) have been used to help with hypocalcemia- A metoclopramide injection (0.1 to 0.2 mg/kg) should
associated aggression. Care must be used with other SC be considered if there was a recent meal ingestion or if some
preparations to avoid skin irritations. A dog-appeasing pher- puppies were already born and the mother has ingested
omone (DAP) diffuser or DAP collar may also be helpful in placentas; in very large litters; or when there is a lot of pres-
creating a calm, comfortable environment in the whelping sure on the stomach, which can facilitate regurgitation or
room. vomiting. Before induction, the female should receive 10 to
In cases of aggression it may be necessary to place 15 minutes of preoxygenation via a mask. Premedication
puppies/kittens in a small plastic box (found at a Walmart with anticholinergics (atropine, glycopyrrolate) may be used
or similar store) that has a heating supply (such as a small to maintain a higher heart rate in the mother. An intrave-
self-contained heating disk [e.g., Snuggle Safe]) and small nous (IV) catheter needs to be inserted, and sodium chloride
Chapter 2 Birth and the First 24 Hours 13

(NaCl) fluids should be given at a surgical rate of 10 ml/kg/ support should include a constant flow of oxygen via a
hr to maintain the proper blood pressure during the surgery. tightly fitted oxygen mask providing positive pressure ven-
For an elective C-section in dogs, short-acting steroids tilation. If this is not effective after 3 to 5 minutes or if the
(Solu-Delta Cortef ) can be administered 2 to 12 hours prior newborn’s heart rate starts to drop, then intubation should
to surgery at a dose of 1 mg/kg and have been shown to be be attempted. Although it is difficult to insert, a 2-mm
beneficial in litter resuscitation. The induction itself may be endotracheal tube or a larger gauge IV catheter could be
performed with propofol (4 to 6 mg/kg) administered intra- used to provide positive pressure ventilation in an attempt
venously or gas induction via a mask. The use of optimal to inflate the lungs. Oxygen toxicity is usually not a major
anesthetic protocols will improve neonatal survival. Certain concern as few neonates are maintained in oxygen-rich envi-
drugs, such as ketamine, thiopental, and xylazine, should be ronment for longer than the first 10 to 15 minutes.
avoided. Once induced, the anesthetic state should be main- Doxapram is thought to work via central stimulation. The
tained with an Isoflurane or Sevoflurane anesthetic gas. A effectiveness of this drug is significantly diminished if the
local block with either a lidocaine or a bupivacaine will brain is hypoxic since the action requires the central process-
help with keeping the anesthesia levels lower until a centrally ing of the incoming signal from the periphery. Thus doxa-
acting analgesic can be given. At this point, it is critical to pram is unlikely to be beneficial to the apneic hypoxic
remove all the fetuses from the uterus as expeditiously as neonate.
possible so that the moderately depressed state from The use of Jen Chung acupuncture point GV26 has been
anesthesia will not worsen the already present distress of advocated by some. A 25-gauge needle is inserted into the
the fetuses, which necessitated the procedure in the first nasal philtrum at the base of the nostrils where it joins the
place. haircoat and rotated clockwise when it reaches the bone.
After all fetuses have been removed, focus can once again Cardiac stimulation should follow ventilatory support
return to the mother and successful completion of the pro- through the use of direct chest compressions. If there is no
cedure. It should also be noted that the sooner the procedure improvement, epinephrine is the drug of choice for neonatal
can be completed and the mother can be safely reunited with cardiac arrest. It has been shown to increase the mean arte-
the newborns the better. After all puppies are removed, a rial blood pressure and improve oxygen delivery to the heart.
standard pain control IV dose of butorphanol or buprenor- Suggested doses of epinephrine range from 10 µg/kg to
phine can be given to keep the mother comfortable. 200 µg/kg IV. Caution should be used with higher doses
because of the risks of associated hypertension. The preferred
Neonatal Resuscitation after Cesarean Section route of administration is either via IV through the umbilical
Resuscitation of neonates delivered by C-section involves vein or via an intraosseous (IO) route through the insertion
mostly the same process as outlined in the section on natural of a 22- or 25-gauge needle into the humerus or femur.
birth, except that many puppies will need resuscitation Endotracheal administration should be avoided because of
simultaneously as opposed to a more evenly distributed and associated vasoconstriction of the tracheal mucosa.
extended timeframe. Additionally, the fetuses that were in Since bradycardia is usually caused by hypoxemia-induced
distress before the C-section began should be given priority myocardial depression and not vagal mediation, the use of
and may require more extreme measures to resuscitate (see atropine is not recommended because it can cause a rebound
next section on more extensive resuscitation measures). tachycardia and exacerbate myocardial oxygen deficit.
Once neonates are pink and breathing well on their own, The use of sodium bicarbonate is controversial but poten-
they should be placed into a warm environment like an tially could be beneficial in the treatment of neonatal acido-
incubator to await their mother’s recovery. At that time, all sis in cases in which resuscitation takes longer than 20 to 30
puppies/kittens should be checked for congenital defects like minutes. This drug should only be administered to a patient
cleft palates, atresia ani, hydrocephalus, and so on. who is well ventilated. The recommendation is to dilute it
1:1 with 5% dextrose (0.5 mEq/ml) and administer at a dose
of 0.5 to 1 mEq/kg IV via the umbilical vein slowly over 2
EXTENSIVE RESUSCITATION MEASURES
to 3 minutes.
After the initial rubbing, suctioning, and stimulating, if a In the past, it was recommended that naloxone (0.1 mg/
newborn does not start to breathe on its own within 30 to kg intramuscular [IM]) should be used in all apneic neo-
60 seconds, then additional and more extensive assistance is nates. This was based on the findings that there is a surge of
required. These more extensive measures should be employed endorphin release during the time of parturition and espe-
after a quick but careful evaluation of the neonate’s condition cially during a stressful birth, which was associated with
because the clinician will want to take the least invasive path respiratory depression in newborns. Modern research has
possible while achieving the same result. showed that the use of this medication is no longer effective
Thicker secretions can be removed through the use of an and may be detrimental if given to a hypoxemic patient since
airway suction catheter in the mouth (DeLee aspirator). This it may worsen the existing bradycardia. It may be beneficial
device provides the application of controlled suction and only in cases in which the neonate shows signs of respiratory
allows inspection of the pharynx to see if meconium may depression and the mother received an opioid injection
have been aspirated because of in utero distress. Ventilatory before or during the C-section surgery.
14 SECTION I: GENERAL CONSIDERATIONS

The clinician should examine all puppies and kittens for closure of the foramen ovale between the atria. Closure of
obvious congenital defects. If severe abnormalities are noted, the ductus arteriosus is not immediate and normally takes
humane euthanasia of the affected neonate(s) should be place within 2 to 5 days after birth.
considered so that resuscitation efforts can be focused on When those closures fail to occur completely, they result
the healthy ones. in conditions called persistent ductus arteriosus or persistent
foramen ovale. This condition can be diagnosed by a char-
acteristic heart murmur and subsequently be confirmed by
RESPIRATORY SYSTEM
an echocardiogram. After birth, the stroke volume of the
During intrauterine life, fetal respiration occurs through a right ventricle increases compared to the left ventricle.
blood-gas exchange process across the placenta. The lungs Because of this, the ratio of the right-to-left ventricular mass
are not in use, and blood flow through them is sparse. During changes from a 1:1 ratio in the newborn to a 1:2 ratio in the
the last few days before birth, with the surge of adrenal adult.
activity, surfactant synthesis is stimulated by cortisol. Thus Overall, in comparison to the adult, newborn puppies and
increased adrenal activity just before birth is essential for the kittens have a lower blood pressure, stroke volume, and
normal lung function postnatally. peripheral vascular resistance but have a higher heart rate,
When the umbilical cord is separated at birth, the blood cardiac output, plasma volume, and central venous pressure.
supply to the fetus through the placenta is suddenly dis- The autonomic innervations of the heart and vasculature are
rupted. This disruption results in a state of hypoxia. Concur- incomplete, thus not giving neonates good baroreflex control
rently, there is an increase in vascular resistance in the of their blood circulation. Myocardial contractility has not
peripheral vessels of the neonate. The combination of these fully developed, resulting in limited compensatory ability to
factors creates a state of dyspnea, which leads to a reflex hemorrhage, hyperthermia, and acid/base imbalances. Last,
contraction of the chest muscles. Negative pressure occurs the heart rhythm of a newborn is a regular sinus rhythm,
in the airways, which causes air suction into the lungs. which is not associated with breathing patterns, because
If a mammal is born alive and the pathway of normal vagal reflexes do not develop until approximately 8 weeks
development and maturation has been followed, the lungs of age.
will float if put in a container of water during postmortem
examination. This flotation indicates the lungs have filled
THERMOREGULATION
with air at least once. This is in contrast to the stillborn
mammal, whose lungs would not float because it was never Thermoregulation is always poor in newborns because their
able to draw air into its lungs. ability to shiver and vasoconstrict in response to decreasing
Respiratory conditions are found quite frequently in temperatures is limited. Also, neonates have a large surface-
fetuses. The most common prenatal condition is hypoxia. area-to-body-mass ratio, little body fat, poor blood flow to
There are many causes for hypoxia; the most common ones the extremities, high water composition, and an inability to
are overcrowding in the uterus, diseased/weakened placenta, pant. This inability to maintain their body temperatures
prematurely detached placenta, and/or shock associated with makes puppies and kittens sensitive to temperature
conditions in the mother. Fetuses are less able to tolerate fluctuations.
hypoxia because their brains are not as well adapted to the After the puppy or kitten is born, its body temperature
reduced oxygen tension and their lungs have yet to inflate to will gradually decrease from the dam’s body temperature to
provide an oxygen reserve. that of a neonate over the first 30 minutes of life (Table 2-1).
Hypoxia in the newborn is usually due to an inability to Immediately after delivery, the mother licks the newborn to
completely inflate the lungs, which can be the result of stimulate and clean it. The puppy/kitten’s natural instincts
inadequate lung surfactant production (most commonly should cause it to move toward the mammary glands, where
found in premature newborns) or because of an airway
obstruction. Since neonates have relatively small airways,
large tongues, and small nostrils, they are susceptible to
hypoxia from the presence of fluid or mucus within the TABLE 2-1 Normal rectal temperatures
airways. for neonates
Recommended
Normal rectal environmental
CARDIOVASCULAR SYSTEM Week temperature temperature
Within the fetal circulatory system, the blood is shunted past Week 1 95° to 99° F (35° to 86° to 90° F (30°
the nonfunctioning fetal lungs through the ductus arteriosus, 37.2° C) to 32.2° C)
which is located between the left pulmonary artery and the Weeks 2-3 97° to 100° F (36.1° 80° to 85° F (26.7°
ascending aorta. When the mother severs the umbilical cord, to 37.8° C) to 29.4° C)
navel circulation stops. In response to increasing oxygen Week 4 99° to 101° F (37.2° 70° to 75° F (21.1°
tension, the ductus arteriosus narrows and the pulmonary to 38.3° C) to 23.9° C)
vessels dilate. Increased left-sided pressure results in the
Chapter 2 Birth and the First 24 Hours 15

the temperature is only slightly below that of the mother.

Thus heat loss is compensated for by the mother, and the TABLE 2-2 Immunoglobulin comparison in
newborn’s thermal balance is maintained. canine colostrum and milk
Hypothermia can develop very fast if environmental tem- Source IgG (mg/dl) IgM (mg/dl) IgA (mg/dl)
peratures are not well controlled (see Table 2-1). Another
Canine 500-2200 70-370 150-340
important factor is humidity, which should be maintained
colostrum
between 55% and 60% to avoid excessive drying of the skin Canine milk 10-30 10-54 110-620
and dehydration.
IgG, Immunoglobulin G; IgM, immunoglobulin M; IgA, immunoglobulin A.

DIGESTIVE SYSTEM
Neonates are born with a sterile gastrointestinal (GI) system. these serum levels should remain high during the first 2
Over the next few days, they will develop their own intesti- weeks of life. Additional information pertaining to altera-
nal flora that will be influenced by the surrounding environ- tions in serum enzyme concentrations is available in Chapter
ment, diet, and their mother. As newborns start to nurse, the 30. If neonates did not receive any colostrum within the first
first milk that they ingest is called colostrum. This first nursing 24 hours, serum can be administered subcutaneously at a
initiates the discharge of meconium, which is a very thick, dose of 5 ml/100 gm of body weight, 3 times at 6 to 8 hour
sticky brown material that has collected in the bowels of the intervals. Hyperimmune canine serum preparations can be
fetus. Failure to discharge meconium can be caused by a lack purchased through Hemo Pet (www.hemopet.org) or
of suckling and mothering behavior or a congenital defect through other regional veterinary blood banks.
such as atresia ani or coli. If the lack of ingestion of colostrum is due to the prob-
The neonate’s digestive system is very fragile and is easily lems with the release of milk or amount of milk present
affected by its diet, the environment, or pathogens because within the mammary gland, then the dam/queen can be
the physical defense against infection is reduced in the given low doses of oxytocin (0.2 to 2 U IM) 15 to 20 minutes
newborn. Since the production of gastric hydrochloric acid before nursing in an attempt to induce milk release. Also,
has not yet fully developed, stomach acidity is lower in neo- metoclopramide (0.1 to 0.2 mg/kg by mouth [PO] 3 times
nates than in adults. As a result of this decrease in the acid a day [TID]) or domperidone (2.2 mg/kg PO 2 times a day
barrier, the defense against infectious agents is decreased, [BID]) have been used to help increase milk production. As
allowing greater survival of bacteria and increased suscepti- a complementary treatment, acupuncture points LI4 and SI1
bility to GI infections. The most common infectious agents have also been used to promote lactation.
in the newborn GI tract are Escherichia coli, Campylobacter
sp., Streptococcus sp., and Clostridium perfringens. The most Weight Gain
common manifestation of GI upset is diarrhea. The puppy or kitten should be weighed at birth. After that,
neonates should be weighed twice a day to accurately
measure weight gain. Digital scales are more accurate and
NEONATAL NUTRITION/COLOSTRUM
gram scales work better for small and toy canine breeds and
SUPPLEMENTATION GUIDELINES felines. Low birth weight can be correlated with poor surviv-
ability in puppies and kittens. Birth weight is not influenced
Colostrum by sex of the neonate and is more likely an indicator of
Since only negligible amounts of maternal antibodies (<5%) inadequate intrauterine nutrition or congenital abnormality.
are passed through the placenta to the developing fetus, an It is normal for neonates to lose a little bit of weight (mostly
adequate ingestion of colostrum must occur within the first water) in the first 24 hours. Neonates that lose more than
24 hours to acquire passive immunity from the mother. Gut 10% of the birth weight in the first day of life have a poor
permeability to immunoglobulins starts to decline 8 hours prognosis. After that, puppies/kittens should gain 5% to 10%
after birth, and no further absorption is possible after 48 to of their birth weight daily. This equates to 1 to 3 gm/day/lb
72 hours. It is good practice to check maternal vaccination of anticipated adult weight for canines and 50 to 100 gm
history before breeding and measure the vaccine titers if the weekly for felines. They should double their weight by 10
history is questionable. days of age.
Table 2-2 shows normal levels of immunoglobulins in A neonate’s caloric requirement during the first week of
canine colostrum versus canine milk. life is 133 calories/kg/day. If the mother’s milk is slow to
If colostrum is not available, then maternal serum can be come in and neonates are not gaining weight, supplemental
administered orally to a neonate less than 12 hours old via feedings of the puppies and kittens will be necessary. Supple-
a feeding tube in the amount of 15 ml/100 gm of body mentation can be provided by feeding with commercially
weight (divided into multiple feedings). available milk replacers such as Esbilac, Just Borne, KMR,
If the ingestion of colostrum is questionable, serum levels Veta-Lac, and others. Puppies get their energy from fat
of alkaline phosphatase (ALP) and gamma-glutamyl trans- during the first week of life, and kittens get their energy from
ferase (GGT) can be checked. If colostrum has been ingested protein. Lactose is not a source of energy, and if the level of
16 SECTION I: GENERAL CONSIDERATIONS

lactose is too high, it can easily lead to diarrhea. When of the incorrect placement. Another indication of incorrect
choosing a milk replacer, it is important to review the prod- catheter placement will be that the tube will not be able to
uct’s energy content to fluid concentration ratio. Because a be inserted fully to the premeasured mark. Once the tube
neonate’s stomach has a limited capacity, it is imperative that has been inserted, a syringe containing the milk replacer is
this ratio be correct to maintain proper hydration and meet attached to the end of the catheter. Correct placement of the
the daily caloric requirement without overextending its fluid feeding tube can also be ensured by the presence of negative
capacity. pressure using the syringe on the end of the tube. Warm an
appropriate amount of commercial milk replacer (based on
Bottle or Tube Feeding the size and age of the neonate) and slowly feed it to the
If a neonate is not gaining weight by itself and doing so at neonate. Monitor for gastric distention. Average stomach
the rate described previously, it will need to receive nutri- capacity in neonates is 0.7 fluid oz (4 teaspoons) per lb
tional supplementation either via bottle or tube feeding. (40 ml/kg). After the feeding is complete, the catheter needs
When choosing a supplementation method, the strength of to be kinked before pulling it out to avoid milk dripping
the neonate is the primary selection criterion. Bottle feeding from the tip and being aspirated into the lungs.
might not be the best for weak neonates because their suckle Neonates being supplemented with milk replacers need
reflex may be diminished and there is a possibility of aspira- to be monitored for constipation. Warm water enemas can
tion into the lungs. In this case, tube feeding might be a be performed as needed if that condition occurs. After each
better alternative. meal, neonates need to be stimulated to urinate and defecate
Regardless of the supplementation method, prior to the by rubbing the perineal and preputial areas with a cotton ball
feeding it is extremely important to make sure that the body that has been soaked in warm water.
temperature of the neonate is above 96° F (35.5° C). If the
neonate’s body temperature is too low, ileus develops and the
IMMUNE SYSTEM
ingested material will start to ferment instead of being
digested, resulting in a bloated and distressed neonate. Puppies and kittens receive virtually no antibodies through
For the neonate unable to be bottle-fed, tube feeding will the placenta. They are born with a relatively immature
be required. This process is not particularly difficult but immune system and are completely dependent on the passive
needs to be done correctly. Depending on the size of the transfer of antibodies through the colostrum. Ingestion of
neonate, the clinician should use either a 5 Fr or 8 Fr red colostrum has to occur within the first 24 hours from birth
rubber catheter. First, measure the distance from the tip of because after that the GI tract will close and prevent absorp-
the nose to the last rib. Then, with a permanent marker, mark tion of antibodies. Mainly, the immunoglobulin G (IgG) and
75% of that measurement on the catheter (Figure 2-1). This A (IgA) antibodies are absorbed since the IgM molecules
mark will guide the length of the tube’s insertion so that it are too large.
correctly reaches the stomach, avoiding kinking of the tube
in the GI tract. While holding the neonate upright with its
head flexed (not extended), insert the tip of the tube along
the roof of the mouth, following the path of least resistance
(Figure 2-2). No force is needed and most neonates will Insert catheter
swallow the feeding tube easily. If the catheter is accidentally to the mark
inserted into the trachea, the neonate might cough as a sign

Measure to the
last rib

Mark at 3/4
measured
distance

Figure 2-1 Preparing for tube feeding. The distance from the Figure 2-2 Passing the orogastric tube. While holding the
tip of the nose to the last rib should be measured first; then, neonate upright with its head flexed (not extended), insert the
with a permanent marker, mark 75% of that measurement on tip of the tube along the roof of the mouth, following the path
the catheter. of least resistance.
Chapter 2 Birth and the First 24 Hours 17

DRUG METABOLISM
The ability to metabolize drugs is reduced in neonates. Renal
clearance is decreased as the glomerular filtration rate does
not develop until the puppy/kitten nears 6 weeks of age.
Hepatic clearance is also decreased, therefore any drugs
metabolized by the liver and kidneys should be avoided or
used with extreme caution. Additional pharmacokinetic dif-
ferences between neonates and adults include increased per-
centage of total body water, decreased percentage of body
fat, decreased albumin concentrations, and decreased binding
to plasma proteins. These differences should be taken into
consideration when selecting the appropriate drugs for
neonates.
The volume of distribution for the water-soluble drugs is
increased, so the dose used in neonates should also be
increased. In contrast, the volume of distribution for the
lipid soluble drugs is decreased. In this case, the dose Figure 2-3 The normal neonatal umbilicus should be dry and
without any redness around it.
in neonates should be decreased. Since elimination is
decreased, the half-life of drugs would be longer and time
between dosing intervals for the neonate should be increased sediment analysis. The blood sample amount collected
as well. should be no more than 1 ml/100 gm of body weight.
If septicemia is suspected in the neonate as a result of
discoloration of the umbilicus or abdominal skin or because
EXAMINATION OF A SICK NEONATE
of other supportive symptoms, aggressive antibiotic therapy
A methodical systemic physical examination should be per- should be instituted immediately. Predisposing factors for
formed on a neonate as it is in the adult animal as follows: this condition are a prolonged delivery or endometritis in
• Oral cavity should be free of congenital defects (e.g., a the mother. A third-generation cephalosporin antibiotic
cleft palate or harelip). (e.g., Naxcel) is one of the better choices because it has
• Hydration status should be assessed by checking mucous minimal effects on the normal GI flora of the neonate. It
membranes. should be administered subcutaneously at a dose of 2.5 mg/
• Skull needs to be examined for the presence of open kg twice daily and continued for 5 days.
fontanelles or large-size skull with domed appearance to During the first few days of life, neonates have reduced
it. clotting capability. Vitamin K-1 may be used at a dose of
• The presence/patency of the anus should be checked. 0.01 to 1.0 mg subcutaneously once because most neonates
• The ability to urinate (by stimulating the area around the have a reduced thrombin level for the first 48 to 72 hrs.
urethral opening) should be verified. Color of the urine
should be checked as a relative assessment of hydration THREE MAIN SYMPTOMS OF ILLNESS
status.
IN NEONATES
• Umbilicus should be dry and without any surrounding
redness (Figure 2-3). The three main symptoms of illness in neonates within the
• Lungs should be clear and free of fluid on auscultation. first 24 hours include hypothermia, dehydration, and
• Abdomen should be soft and not painful. hypoglycemia.
• Neurologic examination consists of checking the three
main reflexes that are listed below. The flexor tone will Hypothermia
predominate until days 3 to 4; thereafter, extensor tone Hypothermia is a very serious problem in the neonate. Gut
will dominate. Presence of any weakness in the following motility slows down when the body temperature decreases,
reflexes indicates an ill neonate: causing ileus of the intestinal tract. Previously ingested milk

Righting response: Evaluating ability of the neonate starts to ferment, produces gas, and leads to bloating. Sub-
to right itself from lying on the back. sequently, there is increased pressure on the diaphragm,

Rooting response: Evaluating the neonate’s ability to which causes labored breathing and dyspnea. These factors
push its muzzle into circled fingers. in turn cause the neonate to swallow more air and thus

Suckle response: Make sure clinician’s fingers are worsen the bloating. Severe bloating can result in circulatory
warm and free of smell/taste. collapse and death. If hypothermic neonates are tube fed, the
The recommended minimum database for further diag- milk replacer is usually regurgitated and aspirated.
nostic workup includes a hematocrit, total protein, blood Neonates are considered hypothermic when their body
glucose, blood urea nitrogen, urine specific gravity, and temperature drops below 96° F (35.5° C); hypothermia
18 SECTION I: GENERAL CONSIDERATIONS

should be treated promptly. Neonates should be slowly the same as the regular IV catheter placement. Fluid is
warmed but not more than 2° F (1° C) per hour. If the body readily absorbed and rates similar to IV administration rates
temperature is raised more than 4° F (2° C) per hour, life- can be used.
threatening organ failure (specifically the heart and kidneys)
can result. Environmental temperatures need to be increased Hypoglycemia
because higher temperatures will help neonates maintain Since puppies and kittens are born with limited glycogen
their core temperature. Neonates should be rotated often to stores, they have minimal capacity for gluconeogenesis.
ensure even warming, and rectal temperatures should be Without nursing, hepatic stores will be depleted in 24 hours,
checked frequently. External heat sources most commonly and hypoglycemia will develop (serum levels dropping to less
used are heat lamps, heating pads, and warm water bottles. than 40 mg/dl). Clinical signs for hypoglycemia include
The latter two need to be used with caution since weak crying, weakness, tremors, coma, and seizures. More in-
neonates might not be able to crawl away from the heat depth information regarding the causes of hypoglycemia can
source, resulting in burns and thermal injury. Warm IV or be found in Chapter 30.
intraosseous (IO) fluids can also be given to raise the body Therefore glucose supplementation is essential for sick
temperatures, but the temperature of the fluids should not neonates. In an emergency situation, dextrose can be given
be more than 2 degrees higher than that of the body. For the IV or IO at a dose of 0.5 to 1.0 g/kg using a 5% to 10%
reasons previously mentioned, a hypothermic neonate should solution or at a dose of 2 to 4 ml/kg of 10% dextrose solu-
never be fed. tion. If the neonate is not too weak, has a good circulation,
and is attempting to nurse, then a 50% dextrose solution can
Dehydration be applied to the gums. IV or SC injections of 50% dextrose
Neonates are especially susceptible to dehydration as a result treatments should never be given because of the potential
of the physiologic immaturity of their kidneys. Although side effects of phlebitis or skin sloughing.
their bodies are more than 80% water, their ability to con-
serve water is significantly diminished since kidneys do not
NEONATAL ISOERYTHROLYSIS IN CATS
fully mature until 6 to 8 weeks of age. The fluid requirement
for neonates is 13 to 22 ml/100 gm of body weight per day. Neonatal isoerythrolysis (NI) is a condition that occurs
Low specific gravity and glucosuria are common normal infrequently in regular domestic kittens but is one of the
findings in neonates. common causes of fading kittens in certain exotic feline
To assess hydration levels in neonates, it is best to check breeds. It results from the immune-mediated destruction of
the moistness of their mucous membranes because skin a kitten’s erythrocytes by its mother’s antibodies. Kittens are
turgor of neonates is not as developed as in adults. If dehy- born healthy, nurse, and ingest maternal IgG antibodies
drated, skin on the ventral abdomen and the muzzle may through the colostrum. NI occurs when kittens of blood type
appear a deeper red color. For severely dehydrated patients, A or AB receive colostral anti-A alloantibodies from a type
the shock dose of fluids can be given as quick bolus of B queen. Kittens with blood type A have weak anti-B allo-
sodium chloride solution at 30 to 40 ml/kg of body weight. antibodies, whereas kittens with blood type B have strong
Subsequently, the percentage of dehydration needed to be anti-A alloantibodies. These kittens are the ones that are
corrected should be estimated. Fluid deficits should be incre- primarily responsible for incompatibility reactions. Affected
mentally corrected over 12 to 24 hours. A maintenance fluid kittens start to show clinical signs within a few hours of
dose in neonates is 3 to 6 ml/kg/hr. Estimated ongoing fluid colostral ingestion. Some might be suddenly found dead.
losses need to be added on top of that. Careful monitoring Others will stop nursing, become weak, and may show
is essential because fluid overload is possible due to the hemoglobinuria. These kittens may then develop jaundice,
diminished kidney function. Fluids can be given via multiple anemia, tachycardia, and tachypnea, leading to death. Kittens
routes: IV, IO, intraperitoneal (IP), or SC. IP and SC routes that survive may develop necrosis of the extremities or tip
are less desirable since absorption rates are slower and less of the tail, which may later slough.
predictable. IV and IO routes are the preferred ways to Affected kittens should be immediately removed from
administer fluids to neonates. It is best to use a microdrip the mother to prevent further absorption of the antibodies.
administration set or a syringe pump to avoid fluid overload. Treatment is primarily supportive. Mild cases can be fos-
A saline solution of 0.45% with 5% dextrose supplementa- tered by the type-A queen or fed milk replacement formulas
tion is recommended. IV catheters are best placed in the for 24 to 48 hours. Severe cases might require blood transfu-
external jugular vein (the cephalic vein can be attempted in sion. Prevention is the key. It is best to blood-type breeding
larger patients). pairs of exotic breeds before breeding. B-type queens should
If an IV catheter cannot be placed, fluids can be admin- only be mated to B-type toms. If accidental breeding of
istered by the IO route. An 18- to 22-gauge spinal needle B-type queen to A-type tom has happened, newborn kittens
can be passed through the trochanteric fossa of the femur or need to be removed from the mother for 24 hours so colos-
greater tubercle of the humerus. The needle is inserted into trum ingestion from the B-type queen does not occur. Addi-
the intramedullary canal, parallel to the long axis of the bone. tional information regarding prevention can be found in
The catheter needs to be placed aseptically and maintained Chapter 1.
Chapter 2 Birth and the First 24 Hours 19

SUGGESTED READINGS Moon P, Pascoe P: Neonatal and pediatric critical care, Proceedings of
the Annual Conference for the Society for Theriogenology, Nashville, TN,
Concannon PW, England GE, Verstegen J, et al (eds): Recent advances in 1999.
small animal reproduction, Ithaca, NY, 2003, International Veterinary Simpson GM, England GCW, Harvey MJ: Manual of small animal repro-
Information Service (www.ivis.org). duction and neonatology, Gloucester, 1998, British Small Animal Veteri-
Hoskins JD: Veterinary pediatrics: dogs and cats from birth to six months, ed nary Association.
3, Philadelphia, 2001, Saunders/Elsevier. Small Animal Neonatology Symposium: Proceedings of the Annual Confer-
Johnson SD, Root Kustritz MV, Olson PNS: Canine and feline theriogenol- ence of the Society for Theriogenology, Lexington, KY, 2004.
ogy, Philadelphia, 2001, Saunders/Elsevier.
 HISTORY AND PHYSICAL
EXAMINATION OF THE NEONATE

C H A P T E R 3
Margaret V. Root Kustritz

In this chapter, the neonatal period is defined as the period • Open-mouth breathing
from birth through 3 weeks of age, or when the puppy or • Nonresponsiveness
kitten is walking and capable of spontaneous urination and • Flaccid muscle tone
defecation. Box 3-1 contains a general overview of impor- • Known trauma or obvious fracture or wound
tant parameters in the physical examination of neonatal dogs
and cats. Number Affected in the Litter
Infectious diseases and parasite infestations of the neonates
and diseases of the bitch are more likely to affect multiple
COLLECTING A COMPREHENSIVE HISTORY
littermates, whereas trauma, congenital disorders, and abnor-
Although clients with a sick puppy or kitten often resent the malities of nursing with subsequent malnutrition are more
time taken by a technician or veterinarian to ask historical likely to affect individual puppies or kittens.
questions, collection of a relevant history leads the veterinar-
ian’s physical examination and any further diagnostic testing Treatments Provided
and may alter plans for therapy. If a significant number of Any fluids, supplements, antibiotics, stimulants, human or
pediatric patients are seen in a practice, it may be beneficial veterinary drugs of other classes, or herbal therapies and any
to use the following history questions to create a history environmental changes made to allay signs of illness should
template that can be filled out (either as a hard copy or be recorded. Obtaining this information may require some
electronically) as puppies and kittens are admitted to the probing from the technician or veterinarian, since owners
practice. may be embarrassed or apprehensive about having used
medications intended for humans or other animals on neo-
Duration of Illness nates. Knowledge of treatments used alters the interpreta-
Knowledge of the duration of illness helps the veterinarian tion of physical examination findings and may alter treatment
differentiate acute from chronic disease and may direct the recommendations.
practitioner toward a specific diagnosis. It also guides inter-
pretation of clinical signs noted on physical examination, for History of the Dam
example, a kitten that has been ill for days and is not dehy- Questions should be asked about the birth of these offspring
drated is probably less severely ill than the animal that has (e.g., were these puppies or kittens delivered vaginally or by
acutely become nonresponsive. cesarean section [C-section] and did dystocia occur at the
time of parturition?); the dam’s current clinical condition
Clinical Signs Noted by the Owner and behavior; history of the dam’s mothering skills if she has
The owner should be asked to specifically list any clinical had previous litters; and health and reproductive history of
abnormalities noted, recognizing that some, such as diarrhea, the dam, including vaccination history.
may be difficult to assess if the bitch or queen is doing a
good job of cleaning the neonate. Some clinical signs indi- Colostrum Ingestion
cate an emergent situation, and any puppy or kitten exhibit- Kittens may receive as much as 25% of their maternally
ing these signs should be seen immediately. Such signs derived antibodies through the placenta; puppies receive 5%
include the following: to 10% at best. Because of this minimal antibody transfer

20