Managing the sick neonate (Proceedings)

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Managing the sick neonate (Proceedings)

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Oct 01, 2008

Objectives

• To recognize the signs of specific illnesses and disease in the sick neonate.

• To review treatment and prevention of common neonatal diseases.

General Key Points

• Although suffering from a variety of different diseases, many sick neonates present with similar clinical signs. Therefore initial treatment should be directed toward those disease processes with a fair to good prognosis, especially when a specific diagnosis cannot be ascertained. Environmental problems, poor mothering or husbandry and bacterial infectious processes carry a more favorable prognosis than viral infections or genetic defects.

• Weakness, anorexia, constant vocalizing or crying, abdominal distention or pain, poor weight gain, poor nursing, restlessness and isolation are the most common clinical signs of illness in the neonate.

Neonatal Mortality

• Common causes of neonatal mortality include congenital abnormalities, teratogens, nutritional deficiencies, trauma, poor husbandry, infection, "low birth weight" and neonatal isoerythrolysis.

• "Normal" mortality rates have been reported as ranging from 15% to 30 or even 40% during the first 12 weeks.

• Normal mortality rates are best evaluated in consideration of the breed, kennel, cattery or breeders historical losses.

• A specific cause of many neonatal deaths is not ascertained, due to a variety of limiting factors.

• The majority of puppy and kitten losses occur either in-utero, at birth (stillborn) or within the first 2 weeks of life.

Presentation of the Neonate

• Neonates may be presented for examination for a number of different reasons. Routine tail docking or dewclaw removal, post-partum check-ups or "clean out" shots, poor weight gain, death of a littermate or clinical signs of illness in the animal.

• Many sick neonates are NOT presented to veterinarians at all (or until death is almost imminent.) Lack of proper understanding of the signs of illness, poor management, financial limitations, the lack of an emotional bond with the newborns, fear of being labeled a "backyard breeder" or even a poor relationship with the veterinarian can delay or prevent the presentation of neonates for treatment.

• Reception and lay staff must be trained to properly handle phone consultations with owners and the emergency presentation of sick newborn animals. Specifically the "to who, with what, where, when and how" of delivering a sick neonate, littermates and dam should be included in all clinic protocols.

Examination of the Bitch or Queen

• A thorough examination of the dam may provide valuable information in diagnosis the neonate's illness. Obtain a thorough and accurate history of the pregnancy, delivery and subsequent care of litter.

• The presence of clinical or subclinical mastitis, metritis, agalactia, eclampsia or sepsis in the dam can contribute to neonatal illness.

• The dams overall condition and nutritional state should be assessed.

• Her reproductive history as well as that of the breed and kennel/cattery should be obtained.

• Littermates should be screened for early signs of disease.

Specific Diseases or Syndromes

1. Fading Puppy/Kitten Syndrome

• The syndrome known as "fading" in puppies or kittens is probably formed by grouping together deaths due to otherwise poorly defined etiologies. The diagnosis is usually applied to those that are born weak and fail to thrive or those that are born apparently strong but weaken and die in the first 7-10 days.

• Possible causes include maternal neglect or trauma, environmental problems, poor colostral intake or inadequate milk production, septicemia, congenital defects including inborn errors of metabolism and neonatal isoerythrolysis in kittens.

• Other theories have indicated possible thymic or thyroid dysfunctions and abnormal surfactant production as potential causes of the syndrome.