Neonatal emergencies: How to help patients survive the critical period - Veterinary Medicine
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Neonatal emergencies: How to help patients survive the critical period
When a decompensating neonate is presented to your veterinary clinic, make sure you're prepared to take life-saving measures to address hypoxia, hypothermia, hypoglycemia, and dehydration.



If a newborn puppy or kitten is completely unresponsive after warming and stimulation efforts, follow the same steps of adult veterinary patient resuscitation (airway, breathing, and circulation).

Airway and breathing. The newborn may need assistance in clearing its airway with a towel, and rubbing the skin over the lumbar area may help stimulate it to cry, further clearing the airway.15 If the airway is still plugged, apply gentle suction with a rubber bulb syringe to the nose and mouth.15 Swinging or slinging is not recommended to clear the airways, as it can result in dropping the animal, cerebral hemorrhage, or aspiration of stomach contents,15 leading to pneumonia.

If a neonate remains unresponsive after the airway has been cleared, administer supplemental oxygen. Use a tight-fitting mask, size 1 or 2 uncuffed endotracheal tube, or size 12- to 16-ga intravenous catheter, and ventilate (applying 20 to 30 cm H2O pressure) until the chest wall expands.15 Once the lungs have been inflated, continue ventilation at a rate of 30 breaths/min at no more than 10 cm H2O pressure, pausing intermittently to check for spontaneous breathing.15 Discontinue ventilatory support after the neonate is breathing on its own. Continue to rub the neonate with a warm towel to help stimulate spontaneous respiration. A 25-ga needle inserted into the nasal philtrum, known as the Renzhong, Jenchung, or GV 26 acupuncture point, is another method that can be attempted to produce spontaneous respiration.17

Circulation. Once a clear airway and breathing have been established, circulation is the next priority for unresponsive neonates. The normal heart rate in newborn puppies and kittens is > 200 beats/min.1 Unlike in adults, bradycardia in neonates does not appear to be vagally mediated.8 The principal reasons for bradycardia in neonates are hypothermia and hypoxia, and addressing these issues with external temperature control and supplemental oxygen will often resolve any circulatory problems. However, if bradycardia persists, perform chest compressions with the thumb and forefinger at a rate of 1 to 2 compressions per second, allowing pauses for breathing.15

Drug administration. Options for drug administration during or after resuscitation are similar to those of adult animals. In neonates, the jugular and umbilical veins are easiest to access.18 Dilute drugs administered in the umbilical vein into a volume large enough to aid in diffusion18 (0.5 ml of a diluent such as 0.9% sodium chloride solution).

Naloxone can be administered to neonates experiencing respiratory depression if opioids were given to the dam before parturition. Naloxone can be given at a dose of 0.1 mg/kg intravenously, intraosseously, intramuscularly, subcutaneously, sublingually, or by endotracheal administration.18

If a neonate is completely unresponsive and has not responded to chest compressions, epinephrine can be given at a dose of 0.1 to 0.3 mg/kg intravenously or intraosseously.15 Doxapram, which is thought to be a central stimulant, has uncertain usefulness in veterinary medicine,15 but it can be attempted at a dose of 0.1 ml of the 20 mg/ml formulation given intravenously or sublingually12 if other means of resuscitation are ineffective.

Atropine is not recommended to treat bradycardia in neonates. These animals are likely bradycardic because of myocardial hypoxia, and further demand placed on the heart only worsens myocardial damage due to increased oxygen demand.8,15

Keep in mind that if any of these drugs are administered without increasing cardiac output, their effect will be minimal as they will not reach peripheral tissues. Perform chest compressions while administering drugs in patients with cardiac arrest.15


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