neonates

  1. first sign of something wrong in SA neonates
    • lack of weight gain
    • kittens: 100g at birth and gain 100g every week, 1lb per month
    • puppies: double birth weight in 7-10d, 5-10% daily increase (breed-dependent)
  2. mucous membranes in SA neonates
    • for hydration, not really color. 
    • Very red at birth, then pale.  But hydration still similar. 
    • Look at abdominal skin for cyanosis, etc.
  3. abdominal skin in SA neonates
    instead of mm - look here since hair coat isn't complete
  4. PE in SA neonates (7, tips, TPR)
    • temp: can recover even at 88F
    • mm: for hydration, not color
    • hair coat: not complete over belly
    • abd skin: instead of mm for color
    • symmetry/conformation: dwarf cats etc!
    • external genitalia: incomplete, catch before necrosis/drying etc!  Testicles descended at birth in cats
    • tail: screw, etc
    • BRING A NORMAL LITTERMATE
    • eyes, ears closed, skin complete, haircoat not over belly
    • T: 94.7-97.3, mom's temp at birth then drops.
    • P: 160-200
    • RR: 10-20
  5. SA PE in first week of life, TPR
    • sleep lots, suckle 2-4h
    • no/few neuromuscular reflexes
    • arrhythmic breathing (don't panic)
    • T: 93.7 - 100.1F
    • P: 200-220
    • R: 16-35
  6. SA PE in 2nd week of life
    • crawling, eyes open, birth weight doubled
    • temp increasing towards normal adult
    • mm starting to be pink, dental ridge starting to appear. Corneas cloudy (still developing)
  7. SA Neonate neuro
    • suckling reflex: offer a finger to a puppy and they'll suckle. Kittens hate the glove, use a reg finger with milk or sugar water
    • righting reflex: put on back, should flip over immediately
    • pressing/Rooting reflex: put a cupped hand in front of puppy/kitten, will press face into hand (to find mammary gland)
    • Lumbar reflex: Rub vigorously over lumbar area. Squeal and move around vigorously. Also helps them breathe when recovering.
  8. Blood samples from SA neonates
    • no more than 10% of circulating IN A WEEK
    • 1mL/100g. 
    • Sick? >0.5mL/100g body weight.
  9. urine samples from SA neonates
    • don't cysto, tissues too fragile
    • Just stimulate with moist cotton ball and catch.
  10. SA Neonate thermoregulation
    • no insulating white fat (only brown)
    • crazy size:surface ratio, increased metabolic rate
    • can't shiver or vasoconstrict until 6-8d
    • normal adult body temp by 6-8wks.
    • CAN'T THERMOREGULATE for 2 weeks (or so).  A hot puppy is from a HEAT LAMP
  11. SA neonate hydration and renal function
    • 82% body water, turnover 2x adults
    • 13-22mL/100g
    • check mm for hydration
    • can't handle replacement fluids quickly, just flood lungs
    • GFR is 21-53% from birth to 8 weeks, tubular secretion from 8wks-6mo. 
    • USG of 1.006-1.017 is pretty normal until 8wks. Before 2 wks, everything gets through, even sugars.
  12. SA Glc regulation in neonates
    • low glycogen stores
    • poor gluconeogenic response
    • Even with minor illness, really difficult to maintain levels (though healthy may maintain for 24h?)
  13. SA DA should be closed
    • within first 3d
    • O2 causes dilation of pulm vessels, closure of DA and correction of acidosis (first HOUR or less in SA)
  14. SA postnatal heart development
    • myocardial cells still dividing so can't contract very well (contractility decreased)
    • autonomic innervation decreased, can't react to circulatory distress (acid-base, blood loss, hypothermia)
    • Heart looks HUGE, lung fields look a little cloudy. Looks round, back to normal looking by 7mo. 
    • RV: LV are 1:1, 1:2 or 1:3 until puberty
    • murmur in first few days prob PDA, just recheck.
    • BP low, CAREFUL with anesthetics
  15. SA Circulation of neonates vs adults
    • lower: BP, stroke volume, PVR
    • Higher: HR, CO, central venous pressure
  16. SA neonate blood cells
    • physio anemia (switching to normal Hb).  PCV TANKS in first week or so, then starts to go back up. 
    • high lymphocytes
    • Reticulocytes, nRBCs
    • high granulocyte counts (naive immune system!)
  17. SA liver function in neonates
    • functional capacity at 8wks
    • some enzymes not until 4-5mo - careful with drugs
    • albumin and plasma protein lower
    • extramedullary hematopoiesis
    • ALP 2-3x higher (bone isoenzyme due to turnover/growth).  1 wk = VERY high, due to colostrum. 
    • clotting factors incomplete
  18. How to tell if a 1wk old SA neonate got colostrum
    ALP REALLY high, like 10,000
  19. Colostrum in SA neonates
    • No transfer pre-colostrum, TOTALLY dependent
    • dogs: 36h okay
    • cats: 16h, maybe 24h
  20. SA Thymus
    • greatest relative size at birth, begins to atrophy at puberty. Immature at birth (reduced T cell response), mature at 3-4mo
    • if trying to "train" immune system to allow, must do be fore 7wks or immune too developed
  21. Immune functions in SA neonates
    • incomplete complement and decreased neutrophil function
    • IgM at birth
    • IgG by 9mo
    • IgA by 6mo
    • LN have scaffold but mostly empty of lymphocytes at birth, facial may be easier to palpate
  22. Colostrum in SA
    • IgG, IgA and IgM, but IgM too big to be uptaken.
    • First 16-24h, lasts until 6-16wks (vax!!)
    • replacement: serum from a well-vax (same species) and inject SQ. Same household vs blood bank b/c tested?
  23. ALP and GGT in SA neonates
    • high concentations due to colostrum, for first 2wks of life
    • NOT Liver disease
  24. Thyroid in SA neonates
    • adult values by 12wks
    • kittens more commonly hypothyroid than puppies.  Esp flat-faced, stand crooked, "pet rock", TEST T4!!
    • T4 should be HIGH in young (1-6wks at least)
  25. adrenal glands in SA neonates
    • EXTREMELY well regulated, lower in 1-6wk old puppies
    • often iatrogenic cushings!!
  26. teeth in SA neonates
    • 4wks: deciduous coming in
    • 8wks: all deciduous in
    • 16wks: adult coming in
    • 32wks: all adult in
    • kittens often earlier
  27. SA fading puppy syndrome
    • 9-26% in neonatal pups (this is TOO MUCH)
    • garbage can diagnoses - environmental, congenital, etc)
    • IMPROVE THE ENVIRONMENT
    • signs: increasing weakness, failure to nurse, weight loss/lack of gain, hypothermia, death before weaning, low birth weight, restless, persistent vocalization, non-specific
    • causes: homozygous deleterious genes, surfactant deficiency, thymic atrophy, infections, toxins
  28. fading kitten syndrome
    • 4-66% in neonates (average of 8% + 10% stillbirth) - fluctuates.  More stillbirths in very large or singleton litters and C-sections (because something is already wrong)
    • signs: anorexia, lethargy, emaciation, death
  29. Kitten mortality complex
    • neonatal mortality, birth defects, repro failures and adult dz (URI, Endometritis, unspecific infections)
    • signs AT BIRTH: stillborn or small/weak, rejection by queens, failure to nurse, dehydration, hypothermia, hypoglycemia, death
    • signs AT WEANING: depression, weakness, anorexia or starvation - WILL STARVE THEMSELVES TO DEATH OVER STRESS, dyspnea or cyanosis, acute heart disease
    • Spikes of death just after birth and at weaning for kittens
  30. neonatal deaths in dogs and cats
    • dogs: just after birth
    • cats: birth and WEANING
  31. sepsis/death in SA neonates, causes
    • viral: (dogs) CANINE HERPES, corona, CPV1, CPV2, CDV, (feline) herpes, panleuk, FIP, FeLV, FIV
    • bacterial: Brucella (dogs #1), klebsiella (puppies raised on wood chips)
    • parasitic: toxo, neospora?
  32. diarrhea in puppies and kittens - causes and dx and tx
    • #1 reason is OVER-FEEDING MILK REPLACER (too rich, add 1/3 water!)
    • Rotavirus: top 1/3 of villi, recover in a few days
    • herpes: soft yellow-green feces, petechiae, thrombocytopenia
    • CPV1: minute virus of canines, sudden diarrhea, quick death
    • CCoV: lethal! 
    • Giardia and coccidia - treat them!
    • Clostridium difficile: enteritis, toxin usu in immune-deficient. From abx? 
    • dx: fecal smear and centrifugation, rads/US (barium), CBC/chem, UA (dehydration = USG 1.020 or higher!).  Herd health may be required - immunohistochem, etc.
    • tx: dehydration, hypoglycemia, reheating, specific tx by dz.
    • campylobacter: azithro, enro (NON-AMBULATORY or causes cartilage damage in pups)
    • clostridium: metro
    • coccidia: baycox (illegal but cidal), Albon
    • giardia: metro, fenbendazole
  33. Canine Herpesvirus dx, tx
    • hx
    • petechiae, ecchymoses (pic of kidney!)
    • abx titers in naive kennel
    • viral cultures
    • intranuclear inclusions
    • tx: colostrum!!  Vidarabine, warmth.
  34. aspiration in SA neonates
    • overfeeding
    • feeding when body temp too low
    • feeding a sick neonate
    • megaesophagus
    • brachycephalic (palate)
    • cleft palate
    • swallowing disorders
    • heart disease - start swallowing air, bloat, regurg and aspirate. Not sure why
    • pain - swallow air, again.
    • causes SECONDARY BACTERIAL INFECTION (immune can also cause these)
  35. drugs for SA neonate URI
    • usu avoid in viral, but secondary bacterial can be catastrophic
    • amoxicillin/clavulonic acid
    • azithro
    • ampi/enro
    • cephalosporin
    • antivirals: famcyclovir, cidarabine, interferons
  36. Colostrum supplementation in SA
    • 150mL/kg serum from well-vax animal. SQ, PO before 12h. Don't give IP - caustic. 
    • don't use bovine colostrum replacer - coming up with a dog version?  
    • MUST be taken up in first 16-24h
  37. Puppy Strangles/juvenile cellulitis
    • autoimmune progressive granulomatous, pustular disorder
    • usu <4mo, rarely up to 4y
    • eyelids, pinnae, lips, chin, muzzle, paws, abdomen, thorax, vulva, prepuce, anus. Usu swollen muzzle
    • lesions can fistulate, drain and crust
    • fever, anorexia, sterile painful arthritis. 
    • dx: appearance! skin scrape for demodex, usu sterile.
    • tx: pred at immune-suppressive doses (2.2mg/kg/day split). Don't vax on this dose, okay once tapering.
  38. Panosteitis in SA
    • lg/giant breeds, 5-18mo. Genetic? Males>females. 
    • acute weight-bearing shifting-leg lameness. Days to 2-3wks. Pain on deep palpation, esp long bones. Walking on eggshells. ulna>radius>humerus>femur> tibia. Up the front and down the back.
    • dx: rads show intramedullary radiodensity 
    • tx: supportive. Steroids? PAIN.
  39. SA Hypertrophic osteodystrophy
    • lg/giant breed, 3-5mo
    • "canine scurvy"
    • cause unknown (not excessive supplementation)
    • metaphyseal (at "discontinuous" metaphyseal vessels). hemorrhage, osteonecrosis, inflammation. VERY painful to touch. 
    • signs: bilateral distal swelling, fore>hind, febrile, pain and warmth on swellings, peracute can be recumbent, depressed, dehydrated, anorectic. 
    • rads: double physis (active physis and osteolysis), pseudophysis. Callus-like periosteal production
    • tx: supportive, START WITH steroids (not NSAIDs because must wait 2 wks if doesn't work!), IV fluids, nutritional support, padding. 
    • Px: good, rare recurrences. Some have permanent deformity causing lameness.
  40. SA Craniomandibular osteopathy
    • 4-8mo
    • usu Westies and Scotties. Unknown cause (but there is a gene)
    • bilaterally symmetric bony proliferation of mandibles, zygomatic arches, possibly radius, femur, ulna. Pain on opening mouth. Can cause dehydration, anorexia, weight loss
    • tx: supportive, steroids. Stops at skeletal maturity, sometimes regresses
  41. Disease prevention in SA neonates
    bitch/queen: proper nutrition (NO RAW), vax, tx/prevent parasites (and treat puppies since mom WILL give them roundworms), clean environment, keep away from new animals in last 4 weeks (herpes)
  42. First care of LA neonate
    • gestational history, placenta inspection
    • vitals, signs of infection/sepsis, congenital defects, dysmaturity/immaturity
    • suckling reflex and response to stimuli
    • colostrum, check for ab transfer
    • dip umbilicus (1:4 chlorhex or 3% iodine)
    • defecation/meconium
    • IM vit E/selenium
    • contracted tendons, angular deformities
    • appetite and growth
  43. TPR of LA neonates
    • >60 at birth, dramatic increase to 120-150 in first 60min as standing. 9h-first week = 80-100
    • RR: 60-80 at first, 30 by 60min usu
    • rectal temp: 99-102. 
    • IMMEDIATELY AFTER BIRTH, HR>60, RR>60 OR TAKE ACTION!!!
  44. prematurity/immaturity or dysmaturity signs in LA
    • CONSTANT monitoring and eval of all systems! Predispose to infections/septicemia, perinatal asphyxia syndrome, resp distress syndrome
    • premature: underweight, short silky haircoat, floppy ears, domed forehead, patent urachus, crias missing mandibular incisor, poor thermoreg, retention of toe caps (usu rub off in birth canal), muscle weakness, dysphagia, inability to digest, diminished suckle, lung and GI immaturity, incomplete ossification, tendon laxity, cria epidermal membrane.
  45. how to check if LA are nursing well
    • dam's udder shouldn't be so full it's dripping
    • check how much urination (pretty much every time they get up) and USG - should be lots and low
    • weight gain
  46. weight gain in alpaca cria, llama cria, foal, calf
    • alpaca: 0.25-0.5lb/day
    • llama: 0.5-1lb/day
    • foal: 1-2lb/day
    • calf: 1-2lb/day
  47. causes of failure of passive transfer in LA neonates
    • Colostrum: IgG > IgM > IgA
    • maternal: poor quality colostrum, pre-partum dripping, severe disease
    • neonate: prematurity/immaturity, perinatal asphyxia syndrome, sepsis
    • 12-24h, peak absorption before 8h.
  48. How to ID failure of passive transfer in LA neonates
    • foals: IgG>800ml/dL.  SNAP test, RID, turbidity test. Snap just gives you 400 or 800, would be better to have real number (2000? 900? 30d half-life, so curve predicts beyond)
    • calves/crias: IgG > 1000 mg/dL (RID, QuickTest, turbidity tests. 
    • calves: TP > 5.2-5.5 g/dL, serum GGT >200 in 24h old, >100 in 4d.  FPT = <50 in 24h.
  49. Nursing: LA Neonate hypoglycemia leads to
    • hypothermia and hypotension
    • neonates have NO energy reserves, so FEED
    • 5-10% body weight/day and increase, GOAL is 20-25% BW/Day
    • add lactase every other feeding to help digestion. Monitor diarrhea and weight gain and adjust. Add dry feed and adjust. 
    • pan feeding safter to prevent aspiration. Tube if necessary
  50. meconium passage
    • starts within a few hours after birth, done within 24h. Takes several BM. Milk feces are more orange and soft. 
    • fetal distress can cause intra-uterine defection, causing meconium aspiration and pneumonia. 
    • impaction in first 24h causing colic, straining, abd distension. Give ENEMA (small volume mineral oil and soapy water, keep amt small!)
    • Neonate should eat dam's feces
  51. umbilical abscess in LA
    • excessive bleeding: ligate or clamp artery
    • abscess: try abx in mild, but can take months (monitor WBC and fibrinogen to check if its helping) and isn't very susceptible. Umbilical resection. Young are susceptible to sepsis!
    • Palpate for moisture - urine or pus. SHould be dry!
    • dip 3% iodide or 25% chlorhex a few times after birth and every few hours. 
    • US: "ET face" - R and L umbilical arteries with a urachus in between.  Look for size symmetry between R and L, should decrease in size with age. 
    • If umbilical VEIN is also infected, could lead to liver disease etc.
  52. patent urachus in LA
    Usu resolve on own, rarely require umbilical resection
  53. umbilical hernia in LA
    reducible or non-reducible? Monitoring for SI entrapment? Umbilical hernia? Smaller is more dangerous.
  54. VSD in LA
    • most common congenital cardiac dz
    • continuous murmur on R side.  There WILL be a systolic murmur on L (PDA - 24h in calves, 1wk-1mo in foals). Investigate on the R!!
  55. Overo lethal white syndrome in LA
    • white foal
    • absence of myenteric ganglia
    • ileocolic aganglionosis
  56. White Muscle Disease in LA (nutritional muscular dystrophy)
    • selenium and/or vitamin E deficiency
    • recumbent, weakness, tachypnea, tachycardia, milk reflux from nostrils, swollen painful muscles, myoglobinuria (kidney disease!!), azotemia, acidosis. 
    • acute: myocardial dystrophy (usu too late to tx)
    • subacute: skeletal muscle dystrophy
    • inject vit E/selenium IM on FIRST DAY OF LIFE - CHECK WHICH SPECIES!!! never IV
  57. nasal milk reflux and regurg
    • abnormal reflux of milk through nostrils
    • from oropharynx, nasopharynx, esophagus/stomach. 
    • causes: cleft palate, pharyngeal obstruction (cyst), esophageal stenosis/ulcer, muscle dysfunction (Se-vitE deficiency), etc. 
    • consequence: aspiration pneumonia
  58. ruptured bladder in LA
    • often during birth or iatrogenic when lifting. Common in immature and premature (bladder more fragile), male>female
    • signs: abnormal urination (small and frequent), straining, mild colic, Uroperitoneum (on US), ventral edema or preputial or vulvar, azotemia, electrolyte imbalance (looks like white muscle!).  Free fluid in abdomen on US
    • LOOKS LIKE MECONIUM IMPACTION.
  59. dx of septicemia in LA
    • neutropenia/philia with LEFT SHIFT
    • TOXIC CHANGES IN NEUTROPHILS
    • lymphopenia, anemia, thrombocytopenia, hyperfibrinogenemia, azotemia, hypoglycemia, metabolic acidosis.  
    • BLOOD CULTURE
    • SEPSIS SCORE x SIRS
    • foals: ceftiofur or TMS or Ampi/penicillin + amikacin + metro for diarrhea
    • calves and crias: ceftiofur, penicillin. Follow AMDUCA.  + (calves) florfenicol, tulathromycin
  60. diarrhea in LA
    • foal heat, poor quality or too much milk replacer, lactase deficiency, infections (e coli like ETEC, C. perfringens/difficile, salmonella, crypto, coccidia, rotavirus, coronavirus in 1+wk old)
    • DEHYDRATION - looks like d has resolved. Life-threatening!  Electrolytes too. 
    • azotemia, abd. distension/colic, albumin loss
    • tx: fluid/electrolytes (corrects dehydration, eletrolytes and hypoglycemia and improves perfusion, BP and renal function).
  61. Respiratory distress syndrome in LA
    • surfactant: produced by type II pneumocytes in late gestation (proteins and phospholipids).  Stabilizes alveoli.  Lack is concern in prematurity or immaturity
    • Lack = increased alveolar permeability leads to HYALINE MEMBRANE FORMATION, causing PROGRESSIVE accumulation of cellular debris and protein within alveoli = ALVEOLAR COLLAPSE. 24-48h
    • No surfactant = airway collapse! 
    • tx with surfactant BEFORE, ASAP!
  62. persistent fetal circulation
    • secondary to lack of surfactant, atelectasis, pulmonary edema. Lack of pressure allows return to FETAL circulation in heart (blood not going to lungs!).  
    • pulm hypertension, lungs offer resistance to air exchange.  Hypoxia, hypercapnia, acidemia
  63. perinatal asphyxia syndrome, dummy foals
    • hypoxic ischemia = anaerobic metabolism, acidosis, endothelial necrosis, energy depletion from Na-K-ATP pump etc = hemorrhage and leakage of osmotic agents = vasogenic edema
    • multisystemic effects: Cardio-resp, neuro, GI, renal, hepatic, endocrine
    • at birth or 24-48h after
    • DUMMY FOAL
  64. neonatal isoerythrolysis
    • foal RBC lysis due to ab transfer through colostrum from mom against fetal RBC. 
    • SEVERE anemia.
Author
XQWCat
ID
335996
Card Set
neonates
Description
Vb neonates
Updated