11-Care of Newborns.pdf

Care of Newborns Chapter 21 PUPPIES & KITTENS What is a neonate? O The neonatal period, for dogs & cats, is the first 4 weeks of life O The puppy or kitten has complete dependency on the mother for survival O Nutrition O Thermoregulation O Care History O Patient O Environment O Milk replacem...

Care of Newborns Chapter 21 PUPPIES & KITTENS What is a neonate? O The neonatal period, for dogs & cats, is the first 4 weeks of life O The puppy or kitten has complete dependency on the mother for survival O Nutrition O Thermoregulation O Care History O Patient O Environment O Milk replacement O Littermates O Any others ill O Weight of others O Bring at least one healthy pup/kitten to compare O Parents O Vaccine status, nutrition, medication/supplements, problems w/previous litters, problems birthing O Relatives Equipment for Examination O Identify the neonates, if there is more than 1 O Markings, different color collars, paint toenails O Pediatric stethoscope O 2-cm bell O Digital thermometer O Measures as low as 85° F O Rapid measurement O Warm, clean surface O Cannot regulate body temperature first 2 weeks of life 5 Physical Examination O Hydration status O Check urine color, not skin turgor O Clear in color (if yellow indicates dehydration) O Body hair O Should cover most of body except ventral abdomen O Lack of hair or sparse hair O Genetic abnormality O Premature birth O Ventral abdominal skin O Should be dark pink (dark red (sepsis) or bluish (cyanosis)—concern) O Discharge from orifices O Abnormal 6 Physical Examination O Check body symmetry O Check body conformation O Head O Neck O Thoracic malformations O Pectus excavatum (flattening) “swimmer syndrome” O Abdomen O Dorsum O Tail O Weight O Puppies – pudgy O Kittens – lean 7 Physical Exam O Specific to neonate (abnormalities): O Presence of open fontanels O Cleft palate O Bulging eyes (behind closed eyelids) O Abnormal formation of nose/external ears O Umbilicus O Umbilical cord dries & falls off by day 2-3 O Bloated abdomen O Genitals/anus First Week Developmental Landmarks O Sleep 80% of day, nurse every 2-4 hours O Reflexes not developed O Only motor skills O Crawling, suckling, purring, and distress vocalization O By day 3 able lift head O Respond to stimuli O Odor, touch, and pain 9 First Week O Elimination initiated by dam O Urination & defecation O Sex determination kittens O Anogenital distance greater in male than female O Males have distinct scrotum; females have vertical slit 10 Sexing Kittens Sexing Kittens Sexing Kittens Body Temperature O Normal neonatal body temperature management O Early on, they depend on proximity to dam to maintain thermal balance O Unable to maintain body temperature O Born – 94.5-97.3oF O 1st week – rises to 94.7-100.1oF O Shivering and vasoconstrictive mechanisms begin at 6-8 days 16 Second Week Developmental Landmarks O Begin to crawl in coordinated manner by end of week 1 O Body temperatures rise toward adult levels O Double their birth weight O Kittens by 7-10 days O Puppies by 10-12 days O Eyes open (7-12 days) O Ear canals open (14-16 days) 17 Third Week O Puppies and kittens able to stand O Good postural reflexes present Obtaining Patient Samples O Blood samples O Jugular vein O No more 10% of circulating volume drawn over a weeks time O If ill no more than 5% circulating volume drawn O Urine samples O O O O Stimulate to urinate Gently express bladder Avoid cystocentesis—organs and skin too fragile Normal to find glucose in the urine of puppies/kittens & specific gravity 1.012-1.020 <4 wks of age 19 Puppy/Kitten Maintenance O Healthy pups/kittens born to healthy dams require little care during the first few weeks of life O If delivered by C-section O Treat umbilical remnant with 1% iodine O Encourage nursing ASAP O Deworming (with pyrantel pamoate) for roundworms begins at 2 wks of age and continued q2 weeks for at least 3 doses O 1st veterinary visit at 6-8 weeks of age O Exam, fecal, vaccines O Client education—nutrition, preventative care, behavior, spay/neuter, microchip Neonatal Problems Hypothermia O Hypothermia defined O At birth O <94°F O 1-3 days of age O <96°F O 1 week of age O <99°F 22 Hypothermia O Causes: O Decreased body temp results in slow GI motility O Leads to ileus O May regurgitate & aspirate leading to pneumonia O Can also cause bloat leads to pain, causing respiratory distress which causes them to swallow more air & more bloat O Ultimately circulatory collapse & death Hypothermia O Clinical signs O >88° F O Restlessness, crying O Red mucous membranes O Skin cool to touch O Respiratory rate >40 bpm O Heart rate >200 bpm O 78-85° F O Lethargy O Uncoordinated, still responsive O Respiratory rate 20-25 bpm O Heart rate <50 bpm O No gut sounds heard O Hypoglycemia (do to impaired metabolism) O Below 70° F O Appears dead O Treat if able to arouse 24 Hypothermia O Treatment O Slowly warm patient (2o F/hour) O Rapid rewarming=heat shock O Can have fatal consequences (delayed organ failure) if raised more than 4oF in 1 hour O Caution w/thermal burns b/c can’t move away from heat source O Warm air & oxygen in incubator or 02 cage O Warm IV fluids (not more the 2o F above body temp) O Nothing PO until warm/audible gut sounds 25 Dehydration O Neonates have increased body water, increased water turnover, and immature kidneys O Tacky to dry mucous membranes indicate 57% dehydration O Fluids should be warmed (98-99o F) unless neonate much colder O Fluid requirement high, but volumes that can be given low Dehydration O Replacement routes O IV – intravenously (maintenance 6mL/kg/hr) O IO – intraosseously (fluid rate same) O IP – intraperitoneally O SQ – subcutaneously – not recommended if hypovolemic (slow absorption rate) Hypoglycemia O Glucose stores small/poor ability to synthesize glucose in underdeveloped liver O Results if fail to nurse after 24-36 hours O BG <30mg/dL in dogs, <50mg/dL in cats O Clinical signs O Tremors, crying, irritability, increased appetite, lethargy, coma, stupor, seizures O Treatment O Oral, IV, or IO dextrose O NEVER GIVE DEXTROSE SQ (can cause tissue damage) O One most common causes of seizures neonates!! Feline Neonatal Isoerythrolysis O Occurs with blood type B queens O High levels (titers) of naturally occurring antibodies against type A red blood cells O Blood type A kitten ingests colostrum from blood type B queen antibodies in the colostrum attack kittens RBCs O Clinical signs O No signs—rare O Jaundice/red-orange urine/death within first 2 days of life O Occasionally tail tip becomes necrotic/falls off 10-14 days of life O Detection O Test at risk kittens at birth O Management O Kittens at risk removed from queen during first 24 hours only 29 Malnutrition O Many commercial milk replacers available O Easily cover caloric requirements but don’t always meet fluid requirements O If only 3 feedings/day provided will need extra fluids SQ for additional fluid requirements O Overfeeding or a high lactose content milk replacer can cause diarrhea O After feeding must be stimulated to eliminate O Daily weight gain monitored until 3-4 weeks old Malnutrition O May require tube feeding to avoid malnutrition in ill neonates or those w/congenital defects O Only tube feed if neonate not hypothermic O Measure from tip of nose to last rib O Mark the tube with permanent marker O Aspirate to make sure get negative pressure O 5mL replacer per feeding to neonate weighing 160g Critical Neonate O Used to be called fading puppy/kitten syndrome, not a particular diagnosis O Causes O Poor management O Malnutrition O Mother or neonate O Inappropriate environmental conditions O Congenital or genetic defects O Infection 32 Critical Neonate O Clinical signs O Anorexia O Lethargy O Emaciation O Birth defects O Stillbirth or weak at birth O Death O Dehydration, hypothermia, hypoglycemia O Can happen initially or after a few weeks of life or at the time of weaning 33 Critical Neonate O Treatment O Supportive care O Removal of inciting causes O Death—necropsy recommended for cases with unapparent cause 34 Orphan Puppy/Kitten Care O Indications: maternal death, abandonment, no milk production by dam, maternal aggression, large litter size, malformation, trauma O Items needed O Warm, clean bedding O Milk bottles, rubber nipples of various sizes O +/- feeding tubes & syringes O Gram scale O Cotton balls O Hand sanitizer O Neonate should be isolated from other animals Orphan Puppy/Kitten Care O Weighed twice daily O Maintain ambient temperature & humidity O First week 84°-90° F O Second week 79°-84° F O Third week 73.4°-79° F O Maintain clean, dry housing O Proper nutrition, hydration & supplementation O Stimulate urination and defecation O After each feeding 36 Bottle Feeding O Use appropriately sized nipples O Evaluate commercial milk replacers available O Energy density, volume O Homemade diets O Use only proven recipes O Weight loss or lack of weight gain first indication neonate is NOT doing well 37 Common Problems with Orphans O Overfeeding O May cause diarrhea O Underfeeding O May cause dehydration and lack of weight gain O Overcrowding O Improper hygiene O Too many foster animals/person O Damp bedding O Cold, drafty environment 38 FOALS Neonatal Period for Foals O Develops rapidly O Suckle reflex within 5-10 minutes O Attempt to rise in 30 minutes, standing w/in 1 hour O Pass meconium (sticky, black fecal material) w/in few hours after birth O May require warm, soapy enema O Nursing successfully w/in 2 hours of birth O First urination around 6-10 hours O At 24 hours should be strong, alert, capable of running O Urinate frequently b/c milk is mostly water O Feces will be yellow/soft (defecation 1-2x/day) 40 Neonatal Period for Foals O Physical exam O BAR O TPR at birth: O Temperature: 99-102° F O Pulse: 60-80bpm; gradual increase to 120bpm O Respirations: 10-20bpm; gradual increase to 30-40 bpm with slight abdominal effort O CRT <2 sec, m.m. moist/pink O Eyes open & bright 41 Neonatal Period for Foals O Physical exam O Born w/o menace response, slow PLR O Quiet systolic murmur may be present but disappears over O O O O O O O time Abdomen should not be swollen Umbilical remnant clean/dry Sleep 10-20minutes, nurse 5 minutes, play, sleep again Gain avg 2-4 pounds daily Normal wide based stance, exaggerated (hypermetric) walking Increased response to stimuli/jerky movements With restraint will struggle at first then go limp (normal) 42 Neonatal Period for Foals O Routine neonatal care: O 1% iodine or 0.5% solution of chlorhexidine to umbilical remnant 3-4x/day for 1-2 days O Monitor attitude, appetite, urination/defecation O If mare not vaccinated tetanus toxoid in last 4-6 wks gestation receive 1500 IU tetanus antitoxin IM 43 Neonatal Period for Foals O Routine neonatal care: O Born w/o antibodies O Drink colostrum w/in 6-8 hours of birth O Check Ab levels 12 hours after birth O Many rapid test kits available O IgG levels >800mg/dL indicate adequate transfer O Failure of passive transfer occurs when IgG level <200mg/dL after 24 hours of age O Reasons for FPT: poor quality colostrum, insufficient colostrum, foal weakness or limb deformity prevents nursing O FPT causes increased susceptibility infection or sepsis 44 Neonatal Period for Foals O Routine neonatal care: O Treatment FPT: O Before 24 hours give foal high quality colostrum from another mare via nasogastric intubation O After 24 hours IV administration plasma from appropriate donor (hyperimmunized donors) O Commercial plasma available O If use on-site donor must cross-match 45 Neonatal Period for Foals O Laboratory evaluations O Parameters neonates distinctly different from adults O Levels of many parameters reach typical adult levels by 1 month of age O Neutropenia w/band cells are not normal and indicate acute infection +/- sepsis O Serum glucose consistently elevated as result of constant nursing 46 Sick Foal O Three main sites entry for bacteria O GI tract O Respiratory tract O Umbilicus O Due to environmental factors compromised foals more likely to develop bacteremia (bacterial infection in bloodstream) & sepsis O Loss of affinity for the mare often 1st clinical sign of neonatal maladjustment syndrome (dummy foal) O Aimless wandering 47 Sick Foal O In utero conditions that predispose some foals to infection O Prematurity O Twins O Placentitis O Inadequate milk production of mare O FPT 48 Sick Foal O Signs of prematurity (born before 320 days of gestation) O Low birth weight/small body size O Weakness/decreased muscle tone O Silky hair coat O Floppy ears O Entropion O Domed forehead O Flexor tendon laxity/angular limb deformities O Unable to rise w/o assistance 49 Sick Foal O Treatment for prematurity (born before 320 days of gestation) O Intensive supportive care O Prone to multiple body system dysfunction or disease processes 50 Sick Foal O Signs of post term foal (past full term gestational age) O Large foal w/longer than expected gestation O Hair coat coarse/long O Incisor teeth erupted O Weak, emaciated O Unable to nurse O Weak suckle reflex O Angular limb deformities 51 Sick Foal O Classic clinical signs critically ill foals O Lethargy O Fever O Depression O Decreased suckle reflex/decreased nursing O Increased recumbency/sleeping O Require 24-hour care/typically referred 52 Sick Foal O Treatment critically ill O Typically stabled w/dam to permit nursing if ambulatory O Recumbent or comatose foal O Padded surface w/eyes protected O Full PE, bloodwork, arterial blood gases (b4 O2 admin) O Tx: Intranasal oxygen (can’t breathe through their mouths) IV catheter (jugular v.)/fluid therapy Broad-spectrum antibiotics if indicated on labwork Slow warming if hypothermic Monitor glucose, urine specific gravity, urine dipsticks, blood pressure O Nutritional support, blood pressure support, ventilator may be needed O O O O O 53 Sick Foal O Once stable further work up to include O Radiographs to r/o pneumonia O Abdominal U/S (meconium retention, bladder, umbilical remnant) O Often develop patent urachus & omphalitis (inflammation of umbilicus) O Foal will strain or dribble small streams when urinating & external umbilical remnant will be moist/enlarged 54 Sick Foal O Complications during hospitalization O Hospital acquired infection (nosocomial) O Addition sites of infection (septic arthritis, osteomyelitis, thrombophlebitis, pneumonia), corneal ulcers, decubital ulcers O Frequent monitoring TPR, asepsis when handling patient/treatment regimens O Kept clean, dry, warm (warm milk to tepid temperature) O Physical therapy O Kept in sternal recumbency (frequent turning side to side every 2 hours) 55 Nutrition O Nurse readily from mare O If unable to nurse O Indwelling nasogastric tube placed & fed every 2 hours O Can remain in place for weeks O Check prior to each feeding for proper placement O Bottle feeding-caution w/aspiration pneumonia O Can milk mare every 2 hours or if mare unavailable use milk replacer (more difficult to digest) O Least desirable way to feed O Bucket feeding-esp for orphan foals O Nurse mare 56 Nutrition O If not tolerating enteral feeding, nutrition can be provided parenterally (IV) using commercial products or recipes (TPN) O Easily grows bacteria use sterile technique & change lines frequently O Hospitalized foals weighed daily 57 Questions?