Jenna Dockweiler, MS, DVM, DACT
Wheat Ridge Animal Hospital, Wheat Ridge, CO
Posted on 2018-10-23 in Theriogenology
Veterinary staff are often poorly trained in the physiology and care of neonatal dogs and cats. Indeed, this is one area of veterinary medicine where many owners and breeders have more skills and experience than veterinarians or technicians! Because of this fact, and because much of the nursing care will be administered by the owner, a team approach between the caregiver and the veterinarian must be taken to maximize neonatal survival.
Management and care of normal neonates
Canine neonatal setup
The whelping box should be a safe place for both mom and puppies. The box should be a comfortable size (about 1.5-2 times the length of the bitch), with enough space for the bitch to stretch out on her side and allow the puppies to nurse. The box should also have pig rails, which are raised ledges that are a few inches off the floor. They should be taller than the puppies until about 3 weeks of age. These provide an escape space for puppies in case the bitch accidentally lays on them.
The puppies must be kept in a warm environment (85-95 F for the first 2 weeks). A heat lamp may be used as a heat source, but this requires close monitoring (measurement of the temperature at puppy level) to avoid dehydration and burns. A lamp should be kept at least 2 feet away from the pups. A great option for heat support is a heating pad with an automatic shut off, with care taken to keep the cords in an area that they cannot be chewed. Another option is to keep the puppy box surrounded by warm water bottles covered with a blanket, but care must be taken to ensure they do not get too cold (this will happen rapidly with water bottles). No matter the heat source, mom and puppies must be able to escape from it if they so choose. My advice is to use common sense – if mom is panting and puppies are sprawled out, the box is likely too warm. If mom and puppies are huddled together, the box may be too cold. Puppies do not have a shiver response immediately after birth, so this reflex cannot be used to assess temperature in the newborn.
The whelping box should be kept away from other dogs (even housemates) to provide privacy. It should be located in a quiet, draft-free area. During the last two weeks of gestation, the bitch should be introduced to the whelping box so she begins to feel comfortable there. The box itself should be constructed from non-porous materials for ease of sanitation. Make sure the bedding materials are comfortable but easy to clean; incontinence pads are great for this purpose as they are highly absorbent. Newspaper can be used for the first few days but should be discontinued once the puppies begin to move around (as this surface is slippery).
Supplies to have handy include hemostats (to clamp umbilical cords if necessary), unwaxed dental floss or suture (to tie off umbilical cords if necessary), a bulb syringe (to clear the mouth and nares of mucous), liquid betadine (to dip umbilical cords), gloves, a gram scale, ID collars, and towels.
Feline neonatal setup
The queening box should be approximately 1.5-2 times the length of the queen (from nose to the base of the tail). The box should be enclosed and have a top, with the entry hole low enough that the queen can enter and exit comfortably but high enough to not allow kitten escape for the first few weeks of life. This box also should be nonporous and can use similar bedding material to a whelping box. Because kittens are small and easily fit into tiny places, the queen, her kittens, and her queening box should be contained in an exercise pen so the kittens are unable to escape once they start exploring. Heat sources and optimal temperatures are similar to whelping box setups.
The litter box should be situated away from the queening box, and food and water should be continually available to the queen (in an area separate from both the queening and litter boxes). Queens will sometimes stop eating as they tend to spend nearly all their time with their kittens, so the kittens may need to be removed for a few minutes each day to allow her to eat, drink, and use the litter box.
Normal premonitory signs of parturition in the bitch include nesting, discomfort, inappetence, increased panting, and occasionally vomiting. These signs are noted at the first stage of parturition, which consists of uterine contraction (which are not typically externally visible) and dilation of the cervix (which is not palpable in the bitch). Rectal temperature usually decreases within 24 hours of the start of parturition to less than 99°F. This temperature drop is due to the sudden decrease of circulating progesterone concentrations, and only lasts approximately eight hours. Green vulvar discharge (uteroverdin) may be noted and should be followed immediately by a fetus as this indicates placental separation. The duration of stage I labor in the bitch is approximately 6-12 hours but may extend up to 36 hours in primiparous bitches.
Stage II labor consists of delivery of the fetus and lasts between zero and 30 minutes per puppy. Approximately 60% of canine fetuses are delivered in cranial presentation, with the remaining 40% delivered in caudal presentation. Both presentations are considered normal if the forelimbs and the hind limbs are extended.
Stage III labor consists of delivery of the placenta and occurs simultaneously with stage II labor in the bitch. It is very common for a bitch to deliver two fetuses followed by two placentas. This is due to the tendency of the fetuses to alternate horns at parturition.
Puppies should be allowed to nurse between deliveries, as this will induce endogenous release of oxytocin and help move the process along.
Normal parturition in the queen often begins with no preceding signs, and no rectal temperature decrease is noted. The three stages of parturition are like those found in the dog but occur over varying periods of time. Queens have reportedly delivered live kittens several days to several weeks apart! Queens are very adept at delivering kittens without incident, and owner interference is a leading cause of dystocia in this species.
Often neonatal resuscitation is at least partially taken care of by the bitch or queen. If not, the fetal membranes are removed from the face, and mucous is suctioned from the mouth and nares using a bulb syringe. The fetus is rubbed vigorously to provide stimulation. Neonates should not be swung, as this can result in cerebral hemorrhage. Once resuscitated, the umbilical cord can be ripped or tied with a small piece of suture (if the dam has not chewed through it) and should be cleaned with a 1-2% iodine solution. Doxapram was once recommended to stimulate respiration, but research in human infants has shown it increases myocardial work without increasing oxygenation and has a low efficacy in hypoxemic states. Epinephrine is only appropriate if the puppy is intubated and chest compressions have already been initiated. Atropine is ineffective, as neonates have an underdeveloped autonomic nervous system and are unable to respond to parasympatholytics. A helpful acupuncture point is governing vessel 26 (GV-26), which is located at the nasal philtrum. Stimulation of this point can help jump start respiration.
The environment should be kept at approximately 85-90°F to maintain stable body temperatures. Puppies and kittens need to nurse within the first six hours of life, as this is when brown fat reserves are depleted. They also must absorb colostrum, as canine and feline placentation only allows minimal passage of immunoglobulins to the fetus. The neonates should nurse every two hours. Constantly restless and vocalizing puppies are a sign of a problem that warrants investigation.
Newborn puppies and kittens are poikilothermic and rely on their environment for thermoregulation. Rectal temperatures for newborn puppies are lower than adult dogs, and they are unable to shiver to maintain warmth (the shiver reflex will develop at about 1 week of age). When neonates become too cold, their organ systems cease to function properly (heart rate decreases leading to hypoxia, gastrointestinal motility decreases leading to ileus and failure to nurse, and white blood cells are less able to fight pathogens leading to sepsis).
Weight gain is the single most important piece of information to evaluation neonatal well-being. It is common for puppies to lose weight within 24 hours after birth, but their weights should increase by 510% of their birth weights daily thereafter (for the first 2-3 weeks of life). As an example, a puppy born at 600 g should gain 30-60 g per day. Kittens typically weigh approximately 100 g at birth and should gain 10 g per day. Puppies and kittens with a low birth weight are at increased risk for death during the neonatal period regardless of subsequent gains. Neonates who fail to gain weight should be supplemented. Supplementation can be delivered via a bottle or an orogastric tube. Bottle feeding is not recommended in neonates under 10 days of age due to an immature swallow reflex. Additionally, bottle feeding should only be attempted in neonates with a vigorous suckle reflex. It is important to never feed a puppy or kitten (using a bottle or a tube) that is hypothermic, as hypothermia leads to ileus which can result in bloat, regurgitation, and aspiration pneumonia.
Neonatal livers contain minimal glycogen stores, and therefore most of the plasma glucose is derived from ingestion. Because of this fact, hypoglycemia occurs rapidly following a short fast. Neonates also lack the feedback mechanism between hepatic gluconeogenesis and blood glucose concentrations, and as such blood glucose regulation is more difficult. Nephrogenesis is not complete until the third week of life and the kidneys are not fully mature until about 8 weeks of age. Concentrations of protein and glucose are higher in the urine of neonates compared to adults. However, urine specific gravity is lower (ranging from 1.006 – 1.020 for the first 8 weeks of life).
Metabolic function of the neonatal liver is also incompletely developed at birth. Drugs metabolized by the liver should be used with caution in young puppies and kittens.
Cardiopulmonary function in neonates differs from adults in that hypoxemia results in bradycardia due to incomplete maturity of the autonomic nervous system (in adults, tachycardia is the response to hypoxemia). Puppies with heart rates in the range of adult dogs are likely severely hypoxemic (kitten heart rates are typically > 200 bpm). Blood pressure is normally lower in neonatal puppies, with mean arterial pressures ranging from 30-70 mmHg during the first four weeks of life. Thereafter, blood pressure begins to increase with age and will reach adult values at about 6-8 weeks of age. Packed cell volume of the puppy and kitten is equal to that of the dam at birth, and slowly declines to 25% at 6 weeks of age.
On a chemistry panel, neonates have high ALP and low albumin. Both are normal findings. In fact, a high ALP shortly after birth can signify adequate colostrum intake (as colostrum is high in ALP, and this enzyme is not broken down by the gut early in development).
Flexion is the predominant posture in the newborn. At about 3-5 days of age, the extensor muscles become dominant. Normal neonates should have a righting, rooting, and suckle reflex at birth. This means a puppy or kitten should roll over when it is placed on its back, should exhibit teat-seeking behavior, and should have a strong suckle response when a finger is placed in its mouth.
Neonatal puppies and kittens have an immature blood-brain barrier, which allows for greater access of drugs into the central nervous system. This phenomenon may result in greater drug efficacy or toxicity.
Like many other mammals, puppies and kittens rely on colostrum from the dam for immunity. After 24 hours of life, little colostrum can be absorbed through the gastrointestinal tract. If neonates do not receive colostrum, a serum transfer should be performed. Serum can be collected from the dam or from another healthy, adult, well-vaccinated dog or cat. The dose in both puppies and kittens is 22 mL/kg PO (if within 24 hours of birth) or SQ (if after 24 hours) and is usually divided over 2 or 3 administrations.
In the normal neonatal puppy, the umbilicus will fall off in 2-3 days and the fontanelle will close at about 3 weeks of age (this is breed-dependent, and some breeds will never have full closure of the fontanelle). The eyes open at 5-14 days of age, and the ears open at 6-20 days of age. Puppies begin to walk between 10 and 14 days of age. They may be started on a gruel mixture at about 3 weeks of age and can be weaned fully (though not taken from their littermates and mother) around 5 weeks of age. Puppies should go to their new homes around 8 weeks of age (or later in some cases).
Developmental milestones for kittens are largely the same as puppies. Their eyes open at 8-10 days of age, and their ears open at about 13 days of age. Kittens begin to walk at about 3 weeks of age. Kittens can be started on gruel at about 4 weeks of age and weaned completely at about 8 weeks of age. Kittens should go to their new homes at about 12 weeks of age.
Management and Care of Ill Neonates
Nonspecific neonatal supportive care
Sick puppies and kittens show a wide variety of symptoms, which may include failure to gain weight, failure to nurse, constant crying, prolonged inactivity, dry mucous membranes, sleeping separated from the group, dark urine, or sudden death. Because of their propensity to decline rapidly, swift treatment for treatable conditions should be instituted (even before diagnostic test results are available).
If a puppy or kitten in a litter has already passed away, the entire puppy should be submitted for histopathology and infectious disease testing to direct treatment for the remainder of the litter.
Treatments that should be immediately instituted for sick puppies and kittens include heat support (until rectal temperature reaches normal for age of neonate – do not overheat!), nutritional support (tube feeding or IV/IO dextrose), antibiotics, and fluid support. Heat is the most important part of supportive care, and body temperature should be corrected prior to instituting other treatments.
Neonates require a fluid rate of 90 mL/kg/day for maintenance and fluid should be warmed prior to administration. A bolus of 30-45 mL/kg can be administered prior to instituting maintenance plus correction for dehydration and losses. Some sources recommend lactated Ringer solution, as lactate is the preferred metabolic fuel in cases of hypoglycemia. Other sources recommend avoiding LRS as neonates are unable metabolize lactate to bicarbonate efficiently. Fluids can be administered via the intravenous or intraosseous route.
Neonates under 4 weeks of age must be assisted with urination and defection by gently stimulating the vulva or prepuce and anus. Urine specific gravity can be measured and used to assess hydration status. Skin turgor in puppies and kittens is not a reliable assessment of hydration as there is very little subcutaneous fat.
If a bloated/distended abdomen is noted, a red rubber catheter can be inserted per os or per anus to relieve gas. If there is gas located in the intestines, pediatric simethicone can be administered (the dose is 1 drop per neonate PO). This is a very common problem in formula-fed neonates.
Hypoglycemia occurs rapidly in puppies and kittens, and as such they must be fed every two hours for the first few weeks of life. Transient juvenile hypoglycemia occurs most commonly in toy breeds (possibly due to lower body energy reserves) and is managed with frequent feedings. Typically, this condition resolves by the time the puppy reaches puberty.
Factors other than fasting that play a role in neonatal hypoglycemia include septicemia, portosystemic shunts, severe hepatic disease, and glycogen storage diseases. Abnormalities in carbohydrate and amino acid metabolism should be considered in puppies with persistent hypoglycemia in the face of adequate nutrition and in the absence of identifiable disease (i.e. septicemia).
Treatment for hypoglycemia involves administration of 5% dextrose at a dose of 0.5-1 g/kg through the jugular vein or an intraosseous catheter. Higher concentrations of dextrose can be applied to the mucous membranes if circulation is adequate. In sick neonates, administration of a dextrose bolus should be followed by a constant rate infusion to avoid rebound hypoglycemia. Specific Neonatal Conditions in the Dog
Canine herpesvirus is a mild upper respiratory infection in adult dogs but causes severe losses during late gestation and early in the neonatal period (last 3 weeks of gestation-first 3 weeks of life). In puppies, there are often no premonitory signs and affected individuals present with sudden death. Canine herpesvirus should be suspected in all cases of neonatal loss. A necropsy in-hospital can be performed to check for characteristic lesions; these will include disseminated multifocal areas of necrosis and hemorrhage over the kidneys, liver, and lungs. Even with antiviral treatment, most puppies with canine herpesvirus will pass away. Those that do survive may have lasting nervous, renal, or myocardial damage. If herpesvirus is suspected, the environmental temperature should be increased to 100°F with 45-55% humidity as the virus replicates poorly in warm environments. The use of acyclovir for littermates of puppies affected by CHV is backed by anecdotal evidence, but due to the narrow margin of safety and possibility of lasting effects of the disease this treatment is not recommended.
External parasites such as fleas are sometimes found in puppies, especially in poor husbandry situations. If left unchecked, ectoparasites can lead to anemia and even death. Unfortunately, control of these parasites is limited to environmental changes and physical removal (such as with a flea comb) until puppies are old enough for commercially-available parasiticides (usually between 4 and 8 weeks of age).
The most common internal parasites in dogs are hookworms, whipworms, and roundworms. Internal parasites can be passed from the dam to the puppies through the transplacental and the transmammary routes (hookworms and roundworms), through fleas (tapeworms), or through ova shed in the bitch’s feces (all parasites). Deworming during pregnancy can help decrease transmission. Roundworms can physically interfere with nutrient absorption and cause intestinal obstruction. Hookworms can lead to severe anemia if left unchecked. Deworming is recommended starting at 2 weeks of age, and regular fecal examinations should be performed to evaluate for parasites that are not routinely covered by broad-spectrum dewormers (such as Giardia).
Specific neonatal conditions in the cat
Neonatal isoerythrolysis can occur in blood type A kittens who are born to blood type B queens. Type B cats have strong antibodies to type A blood antigens. These antibodies are naturally-occurring, meaning queens do not need to have a transfusion or be sensitized through a previous litter to develop them (as is most often the case in humans and horses). Type A kittens ingest colostrum from their type B queens, and with it ingest the anti-A antibodies. Because their gut is open and proteins are not broken down, the anti-A antibodies will enter circulation. This can result in anemia, icterus, tail tip necrosis, lethargy, anorexia, and even sudden death. If caught in time, affected kittens can be removed from their dam and bottle-fed for 24-48 hours (until colostrum is depleted and gut closure has occurred). Severely affected individuals may require a blood transfusion. Responsible breeders of breeds with a high prevalence of type B cats typically blood type their animals prior to breeding (these breeds include the British shorthair, Cornish rex, and Devon rex). In these cases, kittens can be prophylactically removed from their dams when neonatal isoerythrolysis is a possibility.
Upper respiratory infections are common in neonatal kittens and are often caused by feline herpesvirus, Mycoplasma, calicivirus, and Chlamydophila (just as in adult cats). Symptoms are similar to adults, and include sneezing, nasal discharge, inappetence, lethargy, and conjunctivitis. Treatment is most often supportive with antibiotics to prevent and treat secondary infections. Ophthalmia neonatorum is the term for conjunctivitis which occurs under the closed eyelid of the young neonate. Treatment for this condition involves careful separation of the closed eyelid to promote drainage and topical treatment of the eye with antiviral and antibacterial medications. Both internal and external parasites pose a serious threat to kittens as well as puppies. For this reason, deworming is recommended starting at 2 weeks of age. Fecal examinations should also be performed regularly in kittens to address parasites not routinely covered by broad-spectrum parasiticides (such as coccidia). As in the dog, environmental control and physical removal of ectoparasites is required until kittens become old enough for external parasite pharmaceuticals.
Care of ill neonates can be frustrating and can be unsuccessful even if prompt treatment is instituted. In some cases, there may be an invisible underlying disease process that is incompatible with life. However, in many cases, neonates are just off to a rough start and excellent nursing care (provided by veterinary staff and the owner) can reverse their negative trajectory.
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About the author
Dr. Dockweiler graduated from Kansas State University with honors in 2014 and completed a one-year small animal rotating internship at Wheat Ridge Animal Hospital in 2015. She recently completed her theriogenology residency at Cornell University and received her board-certification in 2017. Dr. Dockweiler started the theriogenology service at Wheat Ridge Animal Hospital in 2017.