Examine the umbilicus carefully. Redness, swelling, or discharge indicate infection, usually bacterial. The dried umbilical
cord normally is lost at 2 or 3 days of age.3 Hyperemia and sloughing of the toes, tail, or ear tips are usually caused by sepsis or, in kittens, by neonatal alloimmune
hemolytic anemia. Look carefully for congenital defects such as cleft palates (Figures 5 & 6), open fontanelles, and atresia ani (Figure 7).
Figure 3. A normal rooting response. Note the pup is raising itself on its front legs.
Hydration is important to assess, but skin turgor is not reliable in neonates.11 Mucous membranes should be moist and, for the first four to seven days, are hyperemic because of high red blood cell mass.12 Pale mucous membranes with slow capillary refill time indicate 12% to 15% dehydration.12 In kittens, signs of alloimmune hemolytic anemia include dark-red-brown urine, icterus, and failure to nurse and thrive;
peracute death may also occur.13
Figure 4. A normal suckle response.
A neurologic examination is difficult in neonates, as typical adult responses are not seen until 6 to 8 weeks of age. Flexor
dominance is present for the first four days of life, after which extensor dominance persists until 21 days of age.3 Open fontanelles are common in toy breeds, and their clinical relevance can be difficult to determine. Ultrasonography can
be performed through the fontanelle to look for ventriculomegaly typical of hydrocephalus.14 However, even ventricular dilation may not correspond to the development of clinical neurologic disease.14
Figure 5. Evaluating the palate.
Note whether any developmental landmarks are delayed. The eyelids separate between 5 and 14 days. Menace and pupillary light
responses are typically present at 21 days. Ear canals open at 6 to 14 days. Other benchmarks include crawling at 7 to 14
days, forelimb support at 10 days, and locomotion at 3 weeks of age.3 These are guidelines only and can vary dramatically among breeds and family lines. Teeth appear at about 6 weeks of age,
although this can be considerably delayed in toy breeds.15
Figure 6. A cleft palate and lip.
EXAMINING THE DAM
A dam with even a single ill neonate should have a complete physical examination with particular attention given to her hydration
status, mammary glands including milk production and quality, and vaginal discharge. While some sanguineous vulvar discharge
is normal for about six weeks postpartum in bitches, cytologic examination of the uterine discharge obtained from the vagina
or vulva should be performed to look for postpartum metritis. Normal postpartum cytology of uterine discharge obtained from
the vagina or vulva in bitches may contain uteroverdin (green lochia), red blood cells, and vaginal epithelial cells.16 Numerous neutrophils, degenerate neutrophils, or intracellular bacteria indicate potential metritis. Further evaluation with
ultrasonography of the uterus and cultures are then appropriate.16 Queens usually keep themselves very clean and have scant lochia. Evaluate queens that have notable vulvar discharge after
parturition is complete and the plancentae have passed. Even if postpartum metritis is subclinical, it can provide a continual
source of bacterial contamination for the pups or kittens.
Figure 7. Atresia ani in a puppy.