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.


Intraperitoneal administration

Warmed crystalloid fluids can be given directly into the peritoneum.11 As with subcutaneous fluids, this route is not advised if the patient is severely dehydrated, as fluid will be absorbed more slowly from the peritoneum than with direct venous access. It is important not to give hypertonic fluids intraperitoneally to a dehydrated animal to keep fluids from being pulled from the intravascular space. Also, if this route is used, strict asepsis must be followed to prevent peritonitis.12

Intravenous administration

The jugular vein is the best site for intravenous fluid administration.11 It is highly desirable to place a 20- to 22-ga catheter to prevent repeated venipuncture. Give fluid boluses at 1 ml/30 g body weight over five to 10 minutes2 until mucous membrane color and capillary refill time are normal. Fluid therapy can then be continued at the maintenance rate.

Intraosseous administration

Intraosseous fluids are often the veterinarian's choice for providing fluid therapy to neonates because of ease of access and efficacy. All fluids that can be given intravenously can also be given intraosseously at the same dose and rate.11 Sites that can be used include the greater trochanter of the femur, the tibial tuberosity, the medial process of the proximal tibia, and the greater tubercle of the proximal humerus.14

Clip and aseptically prepare the site to be injected. For pain control, inject a minimal amount of lidocaine (no more than 4 mg/kg) diluted with 50% saline solution or of bupivacaine14 into the skin and periosteum around the planned injection site. A 1- or 2-in, 18- to 22-ga spinal needle is ideal for intraosseous fluid administration. The needle should feel firmly seated and must be removed within 24 hours.11 Proper placement of the intraosseous catheter can be confirmed radiographically.


In many instances, the cause of neonatal death remains unknown. The term fading syndrome refers to a previously healthy full-term puppy or kitten that suddenly deteriorates for no apparent reason, frequently ending in death. Often hypothermia, dehydration, hypoglycemia, and hypoxia are present and lead to the patient's decline, and these may be the only findings of diagnostic tests. Viral or bacterial disease may be the cause, but the animal's deterioration can be so rapid that care must be instituted before test results are available. Multiple causes of disease may be present in a single animal, further complicating the issue.3 Common lesions found in neonates that do not survive involve combinations of pulmonary congestion, edema, hemorrhage, and atalectasis.23 Since the causes can be many and the inciting cause may not be determined before death occurs, supportive care is key for neonates that suddenly show weakness, a slow rate of weight gain, are isolated from the rest of the litter, or otherwise deteriorate in health status.

To ensure the best care of the neonate, a complete physical examination is imperative to identify congenital abnormalities such as cleft palates, atresia ani, open fontanelles, pectus excavatum, and heart murmurs. It is also important to obtain a complete history, including the environment at home, normal feeding patterns for the patient, and if the dam has successfully reared healthy litters. Seemingly healthy and robust puppies and kittens should be separated from those that seem ill.

If blood can be collected from a peripheral vein, first measure blood glucose concentration, then measure packed cell volume and total protein concentration. Puppies 1 to 4 weeks old have a PCV of 32% to 48% and a total protein concentration of 3.4 to 5.2 g/dl. Kittens 1 to 4 weeks old have a PCV of 27% to 35% and a total protein concentration of 4 to 5.2 g/dl.8 Then perform cytologic examination of a blood smear and a white blood cell count. After that perform a complete blood count and serum chemistry profile4 if a sufficient sample remains. Keep in mind the small sample availability; a neonatal kitten has 15 ml of circulating blood, less than 1.5 ml of which can be safely removed for collection.3 A blood bacterial culture can be performed, but treatment should be instituted before results are available.

Urine and fecal samples can also be analyzed. Because renal function is immature, a low specific gravity (1.006 to 1.017), proteinuria, and glucosuria are normal findings in neonatal urine.8


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