Neonatal Care Essentials Quiz

Neonatal Care

• Special Nursing Care for Neonates: Focuses on the care of newborn animals (puppies, kittens, foals).
• Reading Reference: McCurnin's Clinical Textbook for Veterinarians and Nurses (10th Edition), Chapter 21 on Neonatal Care. Text also cites Emergency & Critical Care for Small Animals (4th Edition), by Battaglia & Steele, Chapter 10 (paragraph on posture and positioning) page 129.
• Life Stages of Dogs and Cats: Information is presented in a table. See details in the following points.
  • Pediatric: Birth to 6 Months
  • Neonate: First 4 weeks (cats), First 4 weeks (dogs)
  • Juvenile: 6 months to 15 months (cats), 6 months to 15 months (dogs)
  • Adult: 15 months to 12 years (cats), 15 months up to 7-12 years depending on breed (dogs)
  • Senior: 12 years + (cats), 7-12 years + (dogs)
  • Geriatric: Late senior years (16 years+)(cats), Late senior years (11-16 years) (dogs)
• Emergency C-Section: Possible compromises include fetal heart rate (HR) slowing down due to hypoxia, fetal HR below 180 signals fetal distress, a fetal HR below 160 signals emergency intervention. Problems include hypovolemia in the mother, hypocalcemia in the mother, and hypoglycemia in the offspring. Patient (mother and offspring) stabilization is of utmost importance, along with rapid action.

Neonate Care at Birth

• Clear Oropharynx: Removal of foreign material from the mouth and throat using suction and a gentle technique.
• Ensure Breathing and Mucous Membranes: Checking for proper breathing and the color of mucous membranes. Should be stimulated if needed.
• Oxygen Supply: Administer oxygen as needed.
• Umbilical Cord Management: Clamp, cut, and tie off the umbilical cord.
• Body Massage: Using a dry towel for gentle massage.
• Drugs: Administration of reversal or emergency drugs (opioids or other premedication drugs) using a 25G needle sublingually. Providing emergency drugs as needed.
• Heat and Oxygen Support: Heat and oxygen support for newborns might be necessary.

Physical Examination (PE) of Neonates

• Warm, Clean Blanket: Required for the newborn.
• Pediatric Stethoscope: Used to listen to the heartbeat, checking for abnormalities
  • Digital Thermometer: Measuring body temperature.
  • Skin Turgor: Assessing hydration by checking skin elasticity; Use oral mucous membrane hydration assessment.
• Body and Ventral Abdominal Assessment: Evaluating hair distribution, highlighting areas for normal ventral abdomen coloration to identify potential problems such as cyanosis or sepsis (dark red).
• Physical Assessment Information: Observing for symmetry, normal conformation, and fontanels (open spaces in the skull). Checking nasal anatomy, bulging behind eyelids, umbilical hernia, discharge from umbilicus, or persistent urachus (urine from umbilicus).

Neonate Shape Assessment

• Pups: Described as "mildly pudgy".
• Kittens: Described as "long and lean".

Common Concerns for Neonates

• Hypothermia: A condition where the newborn is too cold.
  • Causes: Little or no subcutaneous fat, high surface area-to-body weight ratio, rapid evaporative heat loss, impaired brown fat metabolism, and inadequate thermogenesis.
  • Leads to: Ileus, impaired immune function, bradycardia, death.
  • Clinical Signs: Cool to the touch, restlessness, crying, red mucous membranes.
  • Treatment: Controlled and monitored ambient warmth, heat pads, lamps, incubators, warm water gloves, raise temperature approximately 1°C per hour, without exceeding this rate.
• Dehydration: A condition where the newborn doesn't have enough fluids.
  • Causes: Increased body water, increased water turnover, immature renal system.
  • Treatment: Fluid therapy (measured in ml/kg/hour), using warmed fluids (body temperature), administering fluids via intravenous (IV), intraosseous (IO), subcutaneous (SQ), or intraperitoneal routes (IP).
  • Clinical Signs: Dry mucous membranes, pale oral membranes (5-7% dehydrated).
• Hypoglycemia: A condition of low blood sugar in newborns which might lead to seizures.
  • Causes: Small glycogen reserves in the liver, limited gluconeogenesis (body's ability to produce glucose). Failure to properly suckle for 24-36 hours.
  • Signs: Crying, tremors, increased appetite, lethargy, coma, stupor, seizures, etc.
  • Treatment: Giving intravenous solutions (i.e., 2.5%-5% dextrose solution in 0.9% NaCl). Bolus of dextrose diluted slowly via IV or IO route; not via SubQ if not using concentrated dextrose. Monitoring blood glucose levels.

Orphan Care Needs

• Warmth: Keeping them warm is a primary need for newborns.
• Feeding: Providing adequate nutrition and food.
• Hygiene: Maintaining cleanliness.
• Elimination: Caring hygiene to ensure healthy functioning elimination.
• Colostrum: Providing colostrum, the first milk, is crucial.

Keeping Warm

• Nesting Box: Use nesting boxes lined with smooth materials.
• Warming Alternatives: Use warm water circulating blankets, warm water bags or hot water bags and heat lamps.
• Neonate Safety: Ensure that the newborn can move away from the heat.

Warming Up

• Warming Slowly: Warming neonates slowly in a controlled environment and monitoring the ambient temperature.
• Warm Inspired Air: Incubators, forced circulating air (e.g., bair hugger).
• Warm Water Gloves/Heat Lamps: Providing warmth using various methods.
• Warm IV/IO Fluids: Using warmed intravenous or intraosseous fluids.
  • Temperature increase rate: Increasing temperature approximately 1 degree Celsius per hour.

Monitoring Temperature

• Normal Neonate Temperature: 35.5 - 36.5°C/at birth to 34.8-38.3 °C the first week. Monitoring body temperature to ensure not falling below the healthy range.
• Hypothermic Neonates: Temperatures below 34.5°C. Signs include shallow breathing, bradycardia, ileus, Impaired GI Function. Do not feed if hypothermic. Untreated hypothermia can cause coma and death.

Nutrition

• Dehydration and Hypothermia Correction First: Correcting dehydration and hypothermia before focusing on nutrition is crucial.
• Dehydration Assessment: Examine oral mucous membranes (dry and pale) to see how dehydrated the animal is.
• Fluid Administration: Correct dehydration with warm intravenous (IV) or intraosseous (IO) fluids.

Feeding

• Bottle/Syringe Feeding: Method to feed (allow to suckle; ensure good swallowing; one to two second intervals between drops).
• Weight Gain Monitoring: Regular weight checks are crucial to ensure proper nutrition and health development.
• Feeding Frequency: Kittens gain 70-100g/week; double weight within 7-10 days.
• Formula Types: Commercial milk replacers, homemade milk replacers (follow a veterinarian's instructions or a specific diet, e.g, McCurnin Table 21-2 to calculate daily feeding needs).
• Food Intake: Ensure feeding for pups and kitten, including weight gain goal data and feeding amount.

Hygiene and Elimination

• Stimulate Voiding: Regularly stimulate voiding after feedings to maintain healthy elimination. Gentle rubbing of the area.
• Age Limit: Sponge baths once or twice a day until approximately 3 weeks of age.

Baby Basics Quiz

• Sleeping Percentage (Week 1): Normal kittens and puppies sleep 80% of the time during their first week of life.
• Heart Rate (Week 1): The normal heart rate for week one puppies and kittens is 200-220 beats per minute.
• Umbilical Cord Fall-Off: The umbilical cord typically falls off on day two of life.
• Eye Opening: Eyes usually begin to open on days 7 to 12.

Test your knowledge on essential nursing interventions and clinical signs relevant to neonates. This quiz covers important topics such as dehydration, hypoglycemia, temperature regulation, and more. Perfect for nursing students and healthcare professionals specializing in neonatal care.