Managing and treating sick neonates (Proceedings) - Veterinary Healthcare
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Managing and treating sick neonates (Proceedings)


CVC IN KANSAS CITY PROCEEDINGS


Nutrition: Always one of the first things an owner is concerned about with a sick puppy or kitten, however it is one of the last items to consider in managing a sick neonate. Once the hypothermia, hypoxia, hypoglycemia and dehydration have been addressed, and then consider nutritional supplementation. Tube feeding with a commercial milk replacement formula initially diluted 50% with LRS is the next step in patient care of the sick neonate.

Neonatal septicemia: Life threatening sepsis occurs when a bacterial infection overcomes a neonates defense mechanisms. Staphylococcus, Streptococcus, E coli, Klebsiella, Enterobacter, Clostridium, and Salmonella are commonly isolated from septic neonates. Ports of entry include the gastrointestinal tract, respiratory tract infection, urinary tract, skin and the umbilical cord. Several pre-disposing issues are responsible for either a decrease in the host's immunity and/or a break in the physical protection barriers. Those co-existing factors include inadequate colostrum, hypothermia, hypoglycemia, poor nutrition, viral infection, endoparasitism, plus metritis and mastitis in the bitch or queen. The clinical sings of septicemia vary with the severity of the condition. Most findings are not pathognomonic for sepsis and may be overlooked. Occasionally death is par-acute with no symptoms noted. Typically neonates should several of the following; prolonged crying, restlessness, weakness, hypothermia, shock, cyanosis. Petechial hemorrhages may be present. In advanced cased there may be discoloration and/or sloughing of distal extremities i.e., toes, ears, tongue, ear tips and tail. Laboratory findings are supportive of the diagnosis. Initially the hemogram will reveal a neutrophillic leukocytosis with a mild left shift. The marrow reserves are rapidly diminished resulting in a neutropenia. A thrombocytopenia is often present. An associated hypoglycemia is usually present.

A septic neonate should be managed as an emergency. Any commonly associated conditions such as hypothermia, hypoxia, hypoglycemia, shock, and dehydration need to be addressed. Prior to initiating antibacterial therapy, any cultures should be taken for submission. Antibacterial selection is empirical in the neonate as little clinical pharmacokinetic data on the appropriate dosing of antimicrobial agents is lacking. Depending on the specific drug, absorption, re-distribution, protein binding, lipid solubility, hepatic metabolism, renal clearance, and poorly developed blood brain barrier influences the dosage regimen. Potential toxicities are an issue. Because absorption of antibacterial following oral, subcutaneous, or intramuscular administration is unpredictable, the antibacterial agents used in septicemia should be administered IV or interosseous if possible.

Published dosages for selected agents;

Amoxicillin 11-22 mg/kg PO/IV BID; Amoxicillin with clavulanic acid 12-25 mg/kg PO BID;

Cephalexin 10-30 mg/kg PO BID-TID ; Cephazolin 10 mg/kg PO/IV BID;

Ticarcillin with clavulanic acid 15 mg/kg IV/IM BID; Trimethoprim Sulfa 30 mg/kg PO Q24H.

Fading puppy/fading kitten syndrome: Puppies and kittens that slowly waste away then die during the neonatal period often referred to as a "fading puppy " or "fading kitten" syndrome. The pups and kittens are born apparently healthy, but nursing slowly ceases, they fail to gain weight, become weak, thin, and eventually die, for no apparently obviously reason. The syndrome represents a myriad of causative agents. Rule outs should include congenital anomalies, nutritional deficiencies in the mother, traumatic birth injury, maternal neglect, and neonatal isoerythrolysis. Infectious agents such as Brucellosis, low grade bacterial sepsis, viral infections (herpes virus, FIP/FeLV) and toxoplasmosis have been incriminated in the "fading" syndrome. Unfortunately, some fading neonates will not survive. Obtaining complete and accurate necropsies is the most expensive and crucial aspect of identifying the cause of the "fading". A necropsy diagnosis may yield information that will be beneficial to the rest of the litter and future litters. The neonate should be kept refrigerated (never frozen) until a trained pathologist performs necropsy. If the necropsy is performed at the clinic, the procedure should include a thorough examination for congenital anatomic defects. Samples of all major organs should be obtained for histology and culture. Formalin-fixed tissues, along with detailed descriptions of gross lesions and clinical histories, should then be forwarded to veterinary pathologists for microscopic examination. If the primary cause of a fading puppy or kitten syndrome is determined, a concerted effort can be made to eliminate the possible reoccurrence in next breeding.


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